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Biomedical subjects

K Savik

Publications and source records attributed to K Savik.

At least 37 records · Page 2Linked to original sources
PubMed1996

Sequential measurement of peripheral blood allogeneic microchimerism levels and association with pulmonary function.

We have shown in lung recipients that high levels of peripheral blood allogeneic microchimerism at 12 to 18 months posttransplant correlated with donor antigen-specific hyporeactivity (i.e., decreased proliferative response to donor antigen in MLC while response to 3rd-party cells remains unchanged); both parameters correlated with an obliterative bronchiolitis (OB)-free state. We have expanded these studies to determine any association of sequential microchimerism levels with concomitant clinical events. In this preliminary study of 7 lung recipients, we used limiting-dilution PCR to quantify peripheral blood microchimerism at serial timepoints ranging from 3 to >48 months posttransplant. These levels were compared with a variety of immunologic and clinical parameters: acute rejection, CMV infection, OB, donor antigen-specific hyporeactivity, and pulmonary function. Pulmonary function was measured per the International Society of Heart and Lung Transplantation: "current FEV1/ baseline FEV1" (FEV1: forced expiratory volume in 1 second). Of the clinical parameters, the association between microchimerism and pulmonary function was the most striking. We observed dynamic patterns of peripheral microchimerism, which reflected the general rise and fall of FEV1. In all 7 recipients, chimerism and FEV1 were high very early posttransplant, then dropped at various rates and to various degrees. After its initial decline, microchimerism increased with FEV1 for the 1 hyporesponsive recipient; for the other 6 recipients, both values declined. These results illustrate, for the first time, that the fluctuation of peripheral blood microchimerism levels is associated with the recipient's clinical condition.

Blood Grouping and Crossmatching↗
PubMed1996

Mortality in patients with acute intermittent porphyria requiring hospitalization: a United States case series.

Acute intermittent porphyria (AIP) is a genetic disorder in which patients may have life threatening attacks of neurologic dysfunction. This study examined the prognosis during the past 50 years of patients in the United States who required hospitalization for porphyric attacks. The cumulative survival was determined for 136 patients with AIP who were hospitalized for porphyric attacks between 1940 and 1988. Diagnosis was established on the basis of clinical symptoms, in combination with increased urinary excretion of porphobilinogen. The patient group had an average age of 32 years (range 9 to 75) at diagnosis and consisted of 43 males and 93 females. At follow-up, 19 males (44%) and 31 females (33%) were decreased. The standardized mortality ratio for the 136 patients, compared to an age-matched hypothetical population experiencing USA 1970 Census Death Rates was 3.2, with a 95% confidence interval of 2.4-4.0. Most deaths occurred during the initial porphyric attack (20% of deaths) or a subsequent attack (38% of deaths). Suicide was also common (five deaths). Comparison was made between 50 patients who were diagnosed before 1971, the year in which hematin therapy became available, and 86 patients who were diagnosed afterward. There was improved survival in the latter group, particularly after 10 years from the time of diagnosis, but this did not reach statistical significance. In conclusion, the proportionate increase in mortality due to symptomatic AIP was three-fold compared to the general population during the past 50 years. The major cause of the increased mortality was the porphyric attack itself.

Adolescent↗
PubMed1996

Primary pulmonary hypertension as a risk factor for the development of obliterative bronchiolitis in lung allograft recipients.

STUDY OBJECTIVES: Obliterative bronchiolitis (OB) is a major factor limiting long-term survival after lung transplantation. The etiology of this disease process remains incompletely understood. Several risk factors have been identified previously, including acute rejection and cytomegalovirus pneumonitis. The purpose of this study was to evaluate primary pulmonary hypertension (PPH) as a potential risk factor for the development of OB after lung transplantation. DESIGN AND PATIENTS: We retrospectively analyzed 107 lung allograft recipients (28 heart-lung, 18 bilateral sequential single-lung, 61 single-lung) who underwent transplantation between May 1, 1986, and April 30, 1994, and survived at least 3 months posttransplant. Mean follow-up posttransplant was 28.6 months (range, 3.5 to 99 months). Actuarial survival was estimated for patients with or without PPH and for those who did or did not develop OB. RESULTS: In all, 25 patients (23.4%) developed OB, diagnosed by strict histologic criteria. Of 23 patients with PPH, 9 (39.1%) developed OB, compared with 16 (19.0%) of 84 patients without PPH (p = 0.044). Actuarial survival, sex, time on waiting list, and follow-up posttransplant were not significantly different between groups. PPH was the major determinant for the development of OB (p = 0.0468) when evaluating PPH and cytomegalovirus pneumonitis together as risk factors. Patients with PPH also developed OB significantly earlier posttransplant, compared with patients with other primary disease (p = 0.05). CONCLUSIONS: Patients with PPH who undergo lung transplantation are at increased risk for the development of OB, which also occurs at a shorter time interval posttransplant. This subgroup needs aggressive monitoring for diagnosis and treatment of OB.

Adolescent↗
PubMed1996

Does donor organ ischemia over four hours affect long-term survival after lung transplantation?

BACKGROUND: Lung transplantation is currently limited by a donor shortage and the need for a short organ ischemic time. The purpose of this analysis was to evaluate prolonged donor organ ischemia and its effect on overall survival. METHODS: We conducted a retrospective analysis of 83 patients undergoing single (n = 62) or bilateral sequential lung transplantation (n = 21) from June 1, 1989, through July 31, 1994. All allografts were flushed with modified EuroCollins solution at 4 degrees C and stored in cold saline solution. Ischemic time was measured from aortic crossclamping at organ procurement to reperfusion. Ischemic times were divided into three groups: group I < 240 minutes (n = 39), group II 240 to 360 minutes (n = 36), and group III > 360 minutes (n = 8). Ischemic times ranged from 97 to 708 minutes (median, 245 minutes; mean, 252 minutes). Bilateral sequential and single lung transplantations were considered together. RESULTS: Actuarial survival was not significantly different among groups (p = 0.09). We found no significant difference in time spent in the intensive care unit (p = 0.27) or in total hospital stay (p = 0.57) after transplantation, in forced expiratory volume in 1 second at 1 month after transplantation (p = 0.74), or in the number of acute rejection episodes (p = 0.65). In addition, length of follow-up was similar among groups (p = 0.24). CONCLUSIONS: Prolonged donor allograft ischemic times were not associated with an adverse effect on survival. The use of allografts with ischemic times through 6 hours achieved acceptable 2-year survival rates after transplantation. The use of donor organs with prolonged ischemic times should prompt the United Network for Organ Sharing to move toward better allocation of donor organs.

Actuarial Analysis↗
PubMed1996

Methotrexate for lung transplant recipients with steroid-resistant acute rejection.

BACKGROUND: Steroid-resistant or recurrent acute rejection is a risk factor for the development of chronic graft failure in lung transplant recipients. The best treatment for these patients is not known. Methotrexate has been used successfully in heart transplant recipients with persistent or recurrent acute rejection. This study was performed to evaluate the efficacy of methotrexate in lung transplant recipients with steroid-resistant acute rejection. METHODS: From January 1991 to December 1995, 12 patients with steroid-resistant acute rejection were treated with methotrexate given weekly for 6 weeks and dose-adjusted according to laboratory data and clinical side effects. After completion of therapy, all patients underwent transbronchial biopsy to evaluate the efficacy of methotrexate treatment. RESULTS: Twelve patients underwent treatment with methotrexate for steroid-resistant acute rejection. Acute rejection resolved in all patients completing at least 4 weeks of therapy; 10 of 12 patients (83%) had no further episodes of acute rejection during a mean follow-up period of 12.5 months (range 1 to 42 months). Acute rejection recurred in two patients 6 and 16 months after methotrexate therapy. Both resolved with high-dose corticosteroid therapy. One patient had asymptomatic cytomegalovirus shedding 8 weeks after completion of methotrexate therapy. One patient had aseptic meningitis after her fourth dose of methotrexate. Neither infectious complication was associated with neutropenia. One patient had bone marrow suppression and neutropenic fevers after augmentation of her methotrexate dose. Two patients received shortened methotrexate courses because of gastrointestinal side effects. CONCLUSIONS: Methotrexate is efficacious in the treatment of lung transplant recipients with steroid-resistant acute rejection. Patients must be monitored for side effects during therapy and dosing must be individualized based on laboratory and clinical parameters.

Acute Disease↗
PubMed1995

Client characteristics associated with not keeping appointments for public health nursing home visits.

Home visits have been identified as an intervention strategy for high-risk pregnant women. A necessary component of this intervention strategy is for the women to be home for the visit with the nurse. The purpose of this study was to identify factors associated with women not keeping their home visit appointments with a public health nurse. Subjects were 232 low-income high-risk pregnant women who received at least one home visit by a public health nurse. Younger age, more stressful life events, receipt of medical assistance, inadequacy of prenatal care, noncompliance with health recommendations, and longer gestational time were associated with not keeping public health nursing appointments. While this study provides some insight into the factors associated with women not keeping their appointments with the public health nurse, further investigation is warranted to identify strategies to reduce the incidence of not-kept appointments.

Adult↗
PubMed1995

Long-term health status and quality of life outcomes of lung transplant recipients.

STUDY OBJECTIVE: Health status and quality of life (QOL) in lung transplant candidates and recipients were compared to determine the impact of transplantation, and whether recipients experience continued improvements in the years after transplant surgery. DESIGN: Two patient groups, adult lung transplant candidates (n = 44) and adult lung transplant recipients (n = 54), completed self-report QOL questionnaires. Eighteen of the 54 recipients completed QOL questionnaires on two occasions, about 18 months apart, after lung transplant. The questionnaire included the Medical Outcome Study Health Survey (MOS 20) that assesses six dimensions of health-related QOL: physical, role and social function, mental health, health perceptions and bodily pain, as well as a self-report Karnofsky Index and other indicators of QOL. SETTING: University medical center transplant service. RESULTS: Compared with candidates, recipients reported higher levels of happiness and more satisfaction with their life and their health. They also reported better function on the Karnofsky Index and in every MOS 20 dimension (p < 0.0001), except pain. No significant differences were found in comparisons among recipients, grouped by the time since their transplant. Eighteen recipients completed two QOL questionnaires after transplant. No significant differences were found between the earlier (median, 11 months) and later (median, 29 months) QOL responses for this group overall. However, recipients (n = 5) who developed obliterative bronchiolitis between assessments showed decrements in their health-related QOL. Dimensions particularly affected were physical and social functioning and bodily pain. CONCLUSIONS: Dramatic improvements in health status and QOL occur after successful lung transplant and remain stable over time. Obliterative bronchiolitis results in notable QOL reductions.

Activities of Daily Living↗
PubMed1995

Bedrest compliance for women with pregnancy problems.

Bedrest has long been recommended for high-risk pregnancies, but recent studies question its effectiveness in improving pregnancy outcomes. To be effective, the women for whom bedrest is recommended must practice it. This study examined degree of compliance and reason for noncompliance in women for whom bedrest was recommended, and outcomes of pregnancy among high-risk women who complied compared with those who did not. The subjects were 326 high-risk pregnant women who were prescribed bedrest for preterm labor, blood pressure problems, or bleeding problems. Of that group, one-third did not comply with the bedrest recommendation. These women had more children, were not currently married, had more stress, did not attend prenatal classes, continued drinking alcohol during pregnancy, and were not trying to get pregnant compared with women who complied. Reasons for noncompliance included the need to care for children, not feeling sick, household demands, lack of partner or family support, need to work, and discomfort. The pregnancy outcomes for the women who complied were similar to those of the women who did not comply. These findings support the importance of more research on the practice of prescribing bedrest to improve pregnancy outcomes.

Bed Rest↗
PubMed1994

Women's experiences with breastfeeding longer than 12 months.

This prospective, longitudinal study was conducted to describe the experiences of 82 primiparas who breastfed longer than 12 months. They were compared with 541 primiparas who weaned their infants within the first year. Greater age, education, and weeks of exclusive breastfeeding were associated with longer duration of breastfeeding. More than two-thirds (68%) of the women who breastfed longer than one year returned to employment before their infant was 1 year old. The most frequently chosen reason for long-term breastfeeding was that breastfeeding was a special time for mother and baby that the mother was not ready to give up. Nearly half of the women reported breastfeeding their babies on demand. At 12 to 15 months, 54 percent of the babies slept in a crib in a separate room, and 37 percent slept in the same bed with their mother all or part of the night. Most mothers (57%) considered their support group to be slightly or moderately important in influencing their decision to breastfeed beyond a year, and 10 percent considered it to be extremely important. The major themes that emerged from women's comments were the importance of being strong in the face of social unacceptability, development of a close mother-child bond, and the naturalness of breastfeeding beyond 12 months. Health caregivers should recognize the emotional and interpersonal aspects of long-term breastfeeding, support the breastfeeding relationship, and avoid contributing to the development of "closet nursers" so that women may feel free to discuss their concerns about their child's health.

Adult↗
PubMed1994

The clinical evaluation tool: a measure of the quality of clinical performance of baccalaureate nursing students.

This article describes an approach to the evaluation of students' clinical performance. Specifically, the paper describes: (a) the history of the evaluation of clinical performance in nursing education; (b) the development of the Clinical Evaluation Tool (CET), an instrument designed to measure the clinical performance of nursing students across settings; and (c) the relationships between basic baccalaureate nursing students' scores on the CET and the following variables: age, college credits earned prior to entry to the program, grade point average at entry, college aptitude, and moral reasoning.

Adult↗
PubMed1993

Are multiple immunopathogenetic events occurring during the development of obliterative bronchiolitis and acute rejection?

The primed lymphocyte test (PLT) has been used to detect donor antigen-specific reactivity of bronchoalveolar lavage (BAL) lymphocytes associated with acute lung rejection and obliterative bronchiolitis (OB). To identify more precisely the immunopathogenetic events related to these processes, we have determined the PLT alloreactivity of 162 BAL specimens from 40 recipients as being directed against individual class I or class II antigens. We used selected homozygous typing cells representing the specific HLA class I and II antigens expressed by the recipient and donor cells. Our previous studies demonstrated a predominant CD8+ cell population mediating class I donor antigen-specific reactivity, correlating with OB in 3 out of 3 recipients tested, and a predominant CD4+ cell population mediating class II donor antigen-specific reactivity, correlating with acute rejection episodes in 13 out of 15 recipients tested. The obstructive airway disease OB, which is frequently fatal, is identified histologically by the presence of small airway inflammation and fibrosis of the lamina propria and lumen, and is characterized clinically by rapidly progressive airflow obstruction. However, a subgroup of patients with histologically proven OB demonstrates stabilization or only minimal progression of airflow limitation after augmentation of their immunosuppressive regimen, usually with high-dose methylprednisolone. To further characterize this subgroup, we tested the BAL-derived lymphocytes from 4 of these patients and observed PLT reactivity that correlated with the class II antigens of the donor, in contrast to the predominant donor class I antigen-specific PLT reactivity of patients with progressive OB. The distinct patterns of PLT reactivity observed for the BAL-derived lymphocytes from patients with the progressive versus the less progressive form of OB suggest that more than one immune process or perhaps different cell targets are involved. Alternatively, these clinical and in vitro findings may represent different stages of the same disease process. Taken together, these results suggest that distinct immunopathogenetic events may be occurring during acute lung rejection and OB.

Acute Disease↗
PubMed1993

Nurse attendee purchasing patterns.

Retention of nursing professionals is crucial in responding to the increasing demand for and complexity of nursing care. Augmenting the decision-making role of nurses is one important retention-related strategy. Purchasing patterns reflect one aspect of nurses' decision-making role. National meetings provide nurses with an opportunity to investigate educational and employment options, as well as to preview technological advances in patient care products and supplies. Yet, the purchasing patterns of nurses related to the marketing of patient care supplies, or educational material at national meetings have rarely been acknowledged or researched. This study investigated the purchasing patterns of nurse attendees as revealed at a national meeting and how attendance influenced purchasing input following the meeting. The study addressed differences in purchasing patterns between specific groups of nurse attendees, as well as the relationship between meeting attendance motivators and purchasing patterns. A descriptive methodology utilizing participant observation at four national nursing meetings and mail survey in four phases was used to determine if there were: (1) identifiable purchasing patterns for nurses attending specific nursing-organization sponsored national meetings, (2) differences in purchasing patterns between nurse attendees from these meetings, (3) differences in self-reported post-meeting purchase input, and (4) relationships between meeting attendance motivators and purchasing patterns. The findings demonstrate that nurse attendee purchasing patterns can be identified and do vary among nursing groups. Nurse attendees at specialty meetings were more likely to act as specifiers, have a more dominant role in purchasing and were more likely to influence product purchases than were nurse attendees from generalist meetings. Self-reports of post-meeting purchasing input demonstrated that nurse attendees utilized information gained at national meetings in subsequent patient care product selections, product utilization and specification of new products/equipment/protocols for trial within the practice site. Positive relationships between meeting attendance motivators and purchasing patterns were most evident for those nurse attendees with greater purchasing involvement and influence.

Adult↗
PubMed1992

Differentiation of class I- and class II-directed donor-specific alloreactivity in bronchoalveolar lavage lymphocytes from lung transplant recipients.

Previous studies have demonstrated that donor antigen-specific primed-lymphocyte-test (PLT) reactivity of bronchoalveolar lavage lymphocytes is strongly associated with acute pulmonary rejection and with obliterative bronchiolitis (OB); however, a systematic analysis of PLT reactivity as being class I-or II-directed has not been performed. To assess reactivity directed against individual class I or II antigens, we tested a total of 67 BAL-derived lymphocyte samples from 26 recipients for alloreactivity in the PLT, using a pool of allogeneic cells and selected homozygous typing cells (HTCs) representing the HLA class I and II antigens expressed by the recipient and donor cells. The results obtained by PLT were correlated with the clinical status of the recipient with regard to rejection, infection, and OB. In 9 of 10 cases where transbronchial biopsy results were consistent with rejection, donor antigen-specific allogeneic PLT reactivity was observed and, more specifically, could be determined to be directed toward donor class II antigen in 8 of these cases. For 3 of 4 recipients tested chronologically, positive donor antigen-specific PLT reactivity was observed at the time of and 2-3 1/2 months prior to the diagnosis of rejection by transbronchial biopsy. During periods of acute infection, donor antigen-specific PLT reactivity was not observed; instead, non-specific PLT reactivity of BAL-derived cells (i.e., reactivity that did not correlate with any defined HLA antigens) was observed as well as reactivity associated with the self-antigens expressed by the recipients' cells. The PLT reactivity of BAL-derived cells from a recipient diagnosed with OB correlated specifically with one of the disparate donor class I antigens (HLA-B44). In 23 cases, BAL cells were propagated in the presence of autologous cells and rIL-2, thereby allowing for sufficient numbers of cells to test with a panel of 29 HTCs and to analyze for cell surface phenotype. The cultured BAL cells from 4 recipients undergoing a rejection episode demonstrated a predominant CD4+ phenotype consistent with the class II-directed reactivity observed in PLT. However, these results did not demonstrate a phenotype distinctive from the 7 BAL results obtained from 4 quiescent recipients. In marked contrast, the cultured BAL cells obtained from 4 recipients diagnosed with OB demonstrated a predominant CD8+ phenotype, with 60-92% of the cultured cells being CD8+. These results are consistent with the class I-directed reactivity observed in PLT.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMedDate not supplied

Women's experiences with combining breast-feeding and employment.

A group of primiparas who combined breast-feeding and employment are described in terms of how they felt about the experience, the difficulties they encountered, factors that affected their total duration of breast-feeding, and patterns of feeding while separated from their infant. These women are contrasted with primiparas who weaned prior to returning to work and those who remained homemakers. Of the 619 women included in the analyses, 499 (80.6%) of the women returned to work or school by 12 months postpartum and 288 (46.5%) continued to breast-feed after returning to work. Women who combined breast-feeding and employment were older, had more years of education, worked fewer hours per week, and more worked in professional jobs than those who weaned prior to returning to work. A number of women who chose to express breast milk only at home thought they would have had problems with having enough time and finding a place to express and to store expressed milk had they tried to express breast milk at work. The overwhelming majority of women who combined breast-feeding and employment felt that it was worth the trouble, that they would recommend it to others, and that they had done something special for their infants that no one else could do. The findings suggest that nursing interventions and workplace accommodations could assist more women to experience the benefits and rewards of continuing to breast-feed after returning to employment.

Adult↗
PubMedDate not supplied

Outcomes of macrosomic infants in a nurse-midwifery service.

The purpose of this study was to compare outcomes of term infants of average birth weight with outcomes of large infants in a nurse-midwifery service. A retrospective study design was used. Data were retrieved from a computer data base that contained information from a data form routinely completed for all births. Subjects were women cared for by the nurse-midwives including those for whom the birth was conducted by a physician. The final n study population was 2,228; 322 (14.5%) of the infants weighed 4,000 g or more. Women who delivered large infants had a significantly higher prepregnant body mass index and pregnancy weight gain. Shoulder dystocia occurred more often in large infants; however, newborn intensive care unit admission rates did not differ between the average birth weight and the large infants. Apgar scores at 1 and 5 minutes were significantly lower for infants weighing > or = 4,500 g compared to those with birth weights of 2,500-3,999 g and those 4,000-4,449 g; however, these differences were not clinically significant. A trend for fewer occurrences of shoulder dystocia in the side-lying birth position was observed. Logistic regression predicting poor Apgar scores (< 7) showed parity as a protective factor and increased gestational age and higher maternal body mass index as predictive of low Apgar scores. Large infants had birth outcomes comparable to those reported by others in the medical literature, suggesting that nurse-midwifery management, including consultation with physician colleagues, can be appropriate and safe.

Adult↗