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Biomedical subjects

K Wright

Publications and source records attributed to K Wright.

At least 199 records · Page 11Linked to original sources
PubMedDate not supplied

Informal care and economic appraisal: a discussion of possible methodological approaches.

The role played by informal carers in the care of people with chronic disabilities is well known. Given its importance, it is essential to consider the evaluation methodology applied in economic appraisals of different care options. Few studies attempt any evaluation and those that do use varied, inconsistent and controversial methodologies. This paper aims to elicit the major issues and methodological problems related to economic appraisal of informal care. The main concern over the present methods utilized is the lack of explicit exploration of the benefits, as perceived by carers. Carers, through their decision to care it is argued, will consider both costs and benefits. Although concepts encompassed by benefits tend to be less tangible they may considerably outweigh any financial burdens. Various methods have been utilized in the past. Financial outlays are fairly straightforwardly costed, personal effort on the part of carers causes more problems. Methods applied include: the cost of substitute services; state benefits; and travel time values. The most useful is probably the latter, although it is not problem-free. Assessing benefits relating to concepts of direct and indirect utility and welfare is more complex and difficult to measure. Despite considerable literature on carers' attitudes, often these concepts are not applied (especially to residential care options) or if they are, negative aspects are emphasized (with domiciliary care). A useful application of economic appraisal would elicit optimal solutions to care dilemmas. Producing economic burden information about informal care may not be particularly constructive. Brief assessment of eight scenarios of care, considering cost differences for the public sector and the preferences of patient and carer gives insight to the problem. It emphasizes the complexity of the issue and the essential role likely to be placed on care managers in helping carers to maximize the net benefit of their efforts.

Caregivers↗
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The impact of nursing grade on the quality and outcome of nursing care.

The large industry which has grown up around the estimation of nursing requirements for a ward or for a hospital takes little account of variations in nursing skill; meanwhile nursing researchers tend to concentrate on the appropriate organisation of the nursing process to deliver best quality care. This paper, drawing on a Department of Health funded study, analyses the relation between skill mix of a group of nurses and the quality of care provided. Detailed data was collected on 15 wards at 7 sites on both the quality and outcome of care delivered by nurses of different grades, which allowed for analysis at several levels from a specific nurse-patient interaction to the shift sessions. The analysis shows a strong grade effect at the lowest level which is 'diluted' at each succeeding level of aggregation; there is also a strong ward effect at each of the lower levels of aggregation. The conclusion is simple; you pay for quality care.

Analysis of Variance↗
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Hepatic artery infusion and chemoembolization in the management of liver metastases.

Hepatic metastases rather than the primary neoplasm usually dictate the course of the disease and patient's survival. For unresectable disease, intraarterial infusion of chemotherapy, embolization, and chemoembolization are viable alternatives. Intraarterial therapy for hepatic metastases is based on the dual blood supply of the normal liver (portal vein, 75%, and hepatic artery, 25%) and that of the tumors (hepatic artery, 90%). Intraarterial infusion delivers a higher concentration of chemotherapy, whereas chemoembolization adds ischemia and increased contact time with the tumor. Selective vascular occlusion for infusion, redistribution of the blood supply and pulsatile flow enhance the delivery of therapeutic agents to the liver.

Antineoplastic Agents↗
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Toxicity and mutagenicity of 6 anti-cancer drugs in Chinese hamster V79 cells co-cultured with rat hepatocytes.

Toxicity and induction of 6-thioguanine-resistant mutants in Chinese hamster V79 cells, co-cultured with or without isolated rate hepatocytes, by 6 anti-cancer drugs (cyclophosphamide, adriamycin, methotrexate, cytosine arabinoside, 6-mercaptopurine and vincristine) were studied. The effect of hepatocyte density on the cloning efficiency and recovery of mutants was found using dimethylnitrosamine as a positive control. In the absence of hepatocytes, this compound was neither toxic nor mutagenic to V79 cells, but in their presence it was highly mutagenic and extremely toxic. The cloning efficiency and mutation frequency of control (untreated) cells was unaffected by hepatocyte density. All the drugs were toxic to V79 cells, although different responses were found for certain of them depending upon whether hepatocytes were present or not. Cyclophosphamide and adriamycin were clearly mutagenic, and 6-mercaptopurine only weakly so. A slight mutagenic effect was seen for cytosine arabinoside, but both methotrexate and vincristine were negative. Here also, the presence or absence of hepatocytes was important.

Animals↗
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Adequacy of disposable biopsy forceps for gastrointestinal endoscopy: a direct comparison with reusable forceps.

Disposable plastic biopsy forceps were compared prospectively to reusable stainless steel forceps. Thirty consecutive patients underwent a total of 249 biopsies, 124 with the disposable forceps, and 125 with reusable forceps. Biopsy locations included the esophagus, stomach, small intestine, colon, and common bile duct. Specimens were compared microscopically to determine overall surface area, depth, adequacy, and diagnostic result. The disposable biopsy forceps yielded specimens which were 37% smaller when compared with the reusable forceps. In five of the comparisons, minor differences in histological findings were noted between the two groups of biopsy specimens, but these differences did not alter the pathological diagnosis. However, in three cases in which superficial specimens were obtained, an underlying carcinoma was missed with the disposable forceps. Our study documents the utility of disposable biopsy forceps for mucosal lesions. In addition, there were 11 mechanical failures in 38 biopsy attempts with the plastic biopsy forceps. These forceps appear to be limited in their capacity to obtain adequate specimens from firm tissue or when submucosal biopsy samples are required, and they will require refinements in design to duplicate specimen quality obtained by traditional reusable forceps. Disposable forceps are particularly suitable for biopsy of mucosal lesions in patients with possible communicable disease, and they should help to reduce cross-contamination in the gastroenterology laboratory.

Biopsy↗
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AIDS protein made.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Improved fluid management utilizing humidified incubators in extremely low birth weight infants.

OBJECTIVE: To compare fluid and electrolyte management in extremely low birth weight (ELBW) infants nursed in humidified versus nonhumidified incubators. STUDY DESIGN: Setting--tertiary intensive care nursery. Subjects--all infants with birth weight < 1000 g admitted 1/95 to 1/99 who were treated with incubators and survived for > 96 hours (N = 155). Intervention--retrospective comparison of daily weights, fluid intakes, urine outputs, and serum electrolytes between group 1 (n = 70, nonhumidified incubators, born 1/95 to 1/97) and group 2 (n = 85, humidified incubators, born 1/97 to 1/99) over the first 4 days after birth. RESULTS: Despite similar daily weight losses between groups, group 1 infants received higher fluid intakes, had lower urine outputs, and had a higher incidence of hypernatremia, hyperkalemia, and azotemia (p < 0.05). Although no differences in mortality or the incidence of patent ductus arteriosus, bronchopulmonary dysplasia, or the overall rate of nosocomial infections were observed, the proportion of gram-negative isolates increased significantly (62%, p < 0.05) following the introduction of humidified incubators. CONCLUSIONS: ELBW weight infants nursed in humidified incubators have lower fluid requirements, improved electrolyte balance, and higher urine outputs during the first 4 days after birth compared to those nursed in nonhumidified incubators.

Bronchopulmonary Dysplasia↗
PubMedDate not supplied

An animal model of occlusion-hyperthermia of the liver.

An animal model of partial hepatic artery occlusion and radiofrequency (RF)-induced hepatic hyperthermia was developed in the New Zealand white rabbit. Seventy-seven percent (10/13) of animals survived partial hepatic artery occlusion, 82% (41/50) survived RF-induced hepatic hyperthermia, and 66% (24/36) survived combined occlusion-hyperthermia. Mesenteric infarction secondary to inadvertent embolization of intestinal arteries was the principal cause of death in animals undergoing partial hepatic artery occlusion. Extrahepatic thermal toxicity appeared to be the major cause of death in animals subjected to hepatic hyperthermia or occlusion hyperthermia although some animals showed evidence of hepatic necrosis as well. Recent developments in our laboratory hold the promise that extrahepatic thermal toxicity can be eliminated by selectively focusing heat into the liver allowing exploration of the efficacy of occlusion-hyperthermia in controlling VX-2 tumors implanted in the rabbit liver.

Animals↗