Biomedical subjects
L Williams
Publications and source records attributed to L Williams.
Why it's great to be a nurse.
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Communication in primary health care.
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Nurses and the media. Turn your radio on.
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Counselling practice: a questionnaire study.
A study was carried out to establish an understanding of what the term 'counselling' meant to a sample of 150 qualified psychiatric nurses working in a maximum security special hospital. There appeared to be a lack of understanding of the term, with very little supervision of the counselling work nurses undertook, and insufficient training to help nurses improve their knowledge of the subject. The authors call for proper supervision, further research into staff training needs, and more courses and propose that nurses involved in counselling should have no ward managerial responsibility for the patients being counselled.
Clinical applications of hematopoietic growth factors.
OBJECTIVE: To explore the history and current clinical uses of hematopoietic growth factors. DATA SOURCES: Recent professional literature and texts dealing with recombinant DNA technology, the development of hematopoietic growth factors, and their use in various disease states. STUDY SELECTION: Not specified. DATA EXTRACTION: Not specified. DATA SYNTHESIS: Hematopoietic growth factors are glycoproteins that regulate the differentiation and proliferation of hematopoietic precursor cells, and, in some cases, the function of mature blood cells. Several have been molecularly characterized and produced in quantity via recombinant DNA technology. Medically, hematopoietic growth factors can be used to replenish hematopoietic lineages by raising cell counts to normal levels; to augment host defenses against infection; to stimulate the immune system against malignancy; and to increase production of effector cells with cytotoxic activities. CONCLUSION: In the past eight years, the hematopoietic growth factors have been used in a variety of clinical settings. They have proven to be effective in stimulating marrow proliferation, increasing circulating blood cell counts, and stimulating various host defense mechanisms. Others are in earlier stages of clinical studies, and their full therapeutic potential remains to be evaluated. New therapies are expected to emerge at a rapid pace.
The correspondence between intention to avoid childbearing and subsequent fertility: a prospective analysis.
CONTEXT: Retrospective studies of pregnancy intendedness have revealed some characteristics that can help identify which women are more likely than others to experience an unintended birth. A comparison of these findings with those from a prospective analysis may shed greater light on the characteristics associated with unintended pregnancy. METHODS: Data were taken from the 1988 National Survey of Fertility Growth and a telephone reinterview of respondents conducted in 1990. Separate analyses were conducted of women intending to postpone childbearing for at least three years and of women intending to forgo all future childbearing. Logistic regression models were used to identify the effects of social and demographic characteristics, as well as change in marital status and certainty of intentions, on the odds of experiencing a birth in the interval between interviews. RESULTS: Only 10% of women intending to postpone pregnancy for more than three years and 8% of respondents seeking to forgo future childbearing had a birth in the interval between interviews. (These births, referred to as unpredicted births in this article, are roughly analogous to those labeled unintended in retrospective analyses.) Women with incomes below the poverty level were 2-3 times as likely as women with incomes between 100% and 199% of poverty to experience an unpredicted birth. Race was not a significant factor among women intending to avoid future childbearing, and became nonsignificant among those intending to postpone when change in marital status and contraceptive status were taken into account. Women aged 35 and older who wanted no more children were significantly less likely than women aged 20-29 to have an unpredicted birth. Women aged 30-34 who wanted to postpone childbearing were roughly 70% less likely than women aged 20-29 to experience an unpredicted birth. Overall, women who were at risk for a pregnancy but not practicing contraception were 2-3 times more likely than women using an effective method to have an unpredicted birth. CONCLUSIONS: There are at least two potential explanations for instances where the correlates of unintended births in the prospective analysis differ from those identified in retrospective studies. Certain subgroups of women may be more likely to classify births as wanted when they are asked retrospectively; alternatively, they may be more likely to experience changes in their living conditions that alter their fertility intentions.
Benefit determination under managed care for substance abuse treatment clients.
The purposes of this study were to examine the process of benefit determination, approval, and variation among Substance Abuse Treatment (SAT) clients. A convenience sample of 20 SAT clients admitted to 1 of 2 treatment programs within Matrix Center were followed. Clients of clinicians who agreed to participate were given an invitation letter to hear more about the study. After informed consent, clients granted 3 interviews and gave permission for the researcher to examine client records to ascertain the benefit determination process. Referral sources were the clients' insurances, their MDs, a counselor, hospital, Employee Assistance Program, case manager, and another treatment program. Ten of the insurances were PPOs, 9 were HMOs, and 1 was a contract. All but 2 had benefits managed by a behavioral care organization (MBCO). Case managers of the MBCOs were all clinicians, most frequently ACSWs. All programs authorized outpatient care and the first approval authorized from 6 to 52 visits. From 1 to 5 different authorizations were used for each client. The co-pay ranged from $0 to $35 per visit. This study illustrates the details of how benefits for substance abuse treatment under managed care are negotiated and used.
Impact of the child's liver transplant on the family: maternal perspective.
This study's purpose was to examine the impact of the child's liver transplant on posthospitalization family adaptation. The family adaptation model provided the framework. Social support was the only variable significantly correlated with family adaptation.
Physiologic and pathologic evaluation of chronic extra-aortic counterpulsation with latissimus dorsi flap. Preliminary results.
This study attempted to evaluate the efficacy of chronic extra-aortic counterpulsation with a latissimus dorsi neuro vascular flap. Five dogs had a preliminary procedure consisting of the creation of a latissimus dorsi flap and a thoracotomy in which the flap was wrapped around the descending aorta just distal to the left subclavian artery. An epicardial lead was placed on the left ventricle and a nerve stimulating lead placed around the thoraco-dorsal nerve. Three weeks later, both leads were connected to a cardiomyostimulator programmed to function in a counterpulsation mode with a 1:2 assist frequency. Hemodynamic measurements were made at 6 and 8 and 10 and 12 weeks and the dogs were sacrificed. Three dogs had all sets of hemodynamic measurements made. Two of the three dogs demonstrated diastolic augmentation at 6 and 8 and 10 and 12 weeks average 20 to 25 mmHg. The third dog failed to demonstrate any change. All dogs were sacrificed at 12 weeks and specimens were submitted for histologic evaluation. The muscle flap was preserved in all animals. The aorta subjacent to the flap showed, (1) normal intima with no evidence of disruption or thrombus in all animals, (2) in the animals in whom counterpulsation was observed, there appeared to be thinning of the media in the aorta subjacent to the muscle flap, and (3) no evidence of distal emboli. This study demonstrated that chronic counterpulsation can be obtained with a latissimus dorsi flap. The actual hemodynamic benefits are not determined from this study. The medial thinning in the aortic wall may limit the long-term benefit of this procedure.
Accident and emergency. Making use of photography.
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Careers: 1992 and beyond.
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The effect of asanguinous cardioplegic arrest on atrial preservation using atrial ATP as a marker.
Changes in atrial adenosine triphosphate (ATP) and the presence of postoperative arrhythmias were studied in 14 patients during routine coronary artery bypass grafting to 1) attempt to evaluate atrial preservation, and 2) determine if a relationship exists between changes in ATP and the development of postoperative arrhythmias. Atrial biopsies were obtained at the time of cannulation (preischemic sample) and after the removal of the aortic crossclamp (postischemic sample). Methods of myocardial protection included systemic hypothermia (28 degrees C), periodic reinfusion of crystalloid cardioplegia into the aortic root and completed vein grafts, and iced slush in the pericardial well. Atrial temperature was monitored. Preischemic ATP was 0.412 +/- 0.32 mu mol/gm, and the postischemic value was 0.220 +/- 0.13 mu mol/gm (p less than .02). Atrial temperature routinely decreased to 13-18 degrees C after cardioplegic infusion but rose to 24 degrees C between infusions. There was no correlation between postoperative supraventricular arrhythmias (4 patients) and changes in ATP. In conclusion, routine coronary artery bypass grafting with standard methods of cardiac preservation does not appear to satisfactorily preserve atrial tissue. The clinical correlation and significance of this remains to be elucidated.