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Biomedical subjects

M A Boyd

Publications and source records attributed to M A Boyd.

At least 19 recordsLinked to original sources
PubMed1994

Primary and secondary care integration.

Integration of primary and secondary health care is a goal of the 1993 New Zealand health reforms. Focus groups were selected to raise options and stimulate improved integration between primary and secondary care in the Auckland metropolitan and rural areas. Cooperation, communication, coordination, were considered relevant. Several detailed recommendations were produced. They fell into six groups; (1) liaison committees or meetings, (2) communication, (3) referral admission discharge, (4) joint ventures, (5) horizontal integration and (6) general. A key recommendation was that regional health authorities should fund liaison committees or functions to promote inter provider integration. The findings of the focus groups are placed in context of the wider requirements for integration. These are integrated funding, integrated information systems, integrated purchasing and utilisation management.

Communication↗
PubMed1992

A target weight procedure for disordered water balance in long-term care facilities.

1. Water intoxication is a severe complication of disordered water balance. Hyponatremia precedes water intoxication and can be identified through abnormal diurnal weight variation. 2. The St. Louis Target Weight Procedure (STWP) is a nonintrusive method that includes a client's baseline weight, frequent weights throughout the day, a target weight of 5% above the baseline weight, and restricted fluids if the target weight is exceeded. 3. The STWP was positively related to an increase in urine concentration; thus it is successful in restoring normal fluid balance.

Adult↗
PubMed1991

Waldenström's macroglobulinemia: long-term results with the M-2 protocol.

Thirty-three patients with symptomatic Waldenström's macroglobulinemia have been treated with the M-2 protocol (BCNU, cyclophosphamide, vincristine, melphalan, and prednisone). Therapy was administered every 5 weeks for 2 years and every 10 weeks for an additional 1-3 years. Median clinical and laboratory parameters included age 70 years (range 52-87), performance status 1 (1-3), prior therapy 7, weight loss 12, symptomatic hyperviscosity 13, splenomegaly 22, lymphadenopathy 7, hemoglobin 9.6 g/dl (6.7-14.6), IgM paraprotein level 2000 mg% (340-11,600), and serum viscosity 2.1 (1.4-6.0). Responses were observed in 27 patients, of whom 21 were partial responses. Survival ranges from 1 to 120+ months with 58% of patients projected to be alive at 10 years. Twenty-one patients remain alive, of whom 10 are greater than or equal to 6 years from initiation of therapy with M-2. Treatment has been well tolerated with usually only mild to moderate hematologic toxicity. Median nadir white blood cells during the first cycle was 3000/mm3 (1000-5500). Peripheral neuropathy was seen in 54% secondary to vincristine. Nausea/vomiting, anemia requiring transfusions, and alopecia were each noted in approximately 25% of patients. Sepsis was observed in 2 patients. Two characteristics, age and prior therapy, were found to be of borderline statistical significance (p = 0.03) using univariate analysis but were not significant with multivariate analysis. The M-2 protocol may be able to produce prolonged survival in the majority of patients with Waldenström's macroglobulinemia. Additional trials are needed to develop recommendations for therapy as well as factors predictive for survival and suitability for treatment.

Age Factors↗
PubMed1991

For those left behind. An educational inpatient rehabilitation program.

1. An interdisciplinary program model was developed for the treatment of mentally ill individuals remaining in long-term state mental institutions that focused on self-maintenance, social functioning, and community living skills. 2. Patients were categorized according to their levels of functioning and diagnoses, and were assigned to programs that were developed to meet the needs of a specific group of patients. 3. The goals of the program were to enhance the quality of life for the patients; promote self-direction and capacity for self-care by increasing the patient's opportunities to make life decisions; and prepare the patients to live in a less restrictive environment.

Activities of Daily Living↗
PubMed1991

When they drink too much. Nursing interventions for patients with disordered water balance.

Disordered water balance affects as many as 60% of severely psychiatrically disabled persons. Most patients do not progress to the point of a medical emergency, but are in a state of mild chronic intoxication, making them unavailable for treatment and requiring nursing care to treat the effects of the chronic intoxicated state. Interventions depend on the severity of the disordered water balance and vary from teaching fluid intake control to controlling all patient access to fluids. Nursing management of water intoxication is a trial and error approach. Through a thorough assessment and close observation of the patient, the nurse can determine which interventions would be most appropriate for the patient.

Humans↗
PubMed1991

Accreditation of predoctoral dental education: clinical outcomes assessment.

The Curriculum Outcomes Review and Evaluation (CORE) system of outcomes assessment used in the accreditation of Canadian Dental Faculties by the Commission on Dental Accreditation of the Canadian Dental Association is described. The CORE system, which has become an integral part of the regular accreditation site visit of Canadian dental predoctoral programs consists of (a) two methods of chart review, (b) assessment of the performance of a random sample of final year students in both diagnosis and treatment planning and in case presentation, (c) a structured observation in the clinical setting, (d) the application of a detailed and focused survey instrument prior to the site visit, and (e) the solicitation of feedback from involved students, faculty members, school administrators and accreditation site visitors. The overall response to the CORE program was favorable and plans to expand the program to dental hygiene accreditation are described.

Accreditation↗
PubMed1990

Polydipsia in the chronically mentally ill: a review.

Polydipsia, or excessive intake of water, is reviewed in the chronically mentally ill from a nursing perspective. The purpose of this article is to review research related to excessive water ingestion, the magnitude and types of problems that these patients experience, and the treatment interventions reported. Future research and practice should focus on understanding the patient's experience of polydipsia and how it relates to the patient's level of functioning, testing assessment tools, and determining appropriate interventions.

Chronic Disease↗
PubMed1990

Living with overweight.

Aided by nurses using the belief clarification approach to intervention, a group of 20 females participated in eight structured sessions that addressed their beliefs and attitudes about being overweight. One participant redefined her negative experience into a more positive and realistic one that included recognizing additional sources of stress that contributed to low self-esteem and negative body image. The overweight experience is discussed in terms of unrealistic expectations of dieting and weight loss.

Adaptation, Psychological↗
PubMed1990

Provincial origin of first-time writers of the Canadian Dental Aptitude Test.

A brief summary of the current status of the Canadian Dental Aptitude Test (CDAT) is presented. The number of first-time writers of the CDAT is reported by the province of their preference as designated by the candidate on the test application form. Anomalies in the numbers taking the test are discussed and relationships with other provincial and regional parameters developed. It is clear that the effect of the policy change at the University of Toronto, where the CDAT is no longer required for admissions purposes, has had a major effect on the numbers taking the test and the information available about the demographics, quality and size of the Canadian dental school applicant pool. The regional and provincial differences highlighted include a relatively smaller applicant pool in British Columbia, Manitoba and the Atlantic Provinces in addition to a relatively limited educational opportunity for potential dental professionals in British Columbia, Ontario and the Atlantic Provinces.

Aptitude Tests↗
PubMed1989

First year enrollment of Canadians in North American dental schools.

Data is presented relating to the number of students admitted to the first year classes of Canadian dental schools for the period 1974 through 1988 and projections for 1989. Additional data showing the number of non-Canadians in Canadian dental schools and the number of Canadians enrolled in the first year of United States dental schools is included. The study concludes that the number of Canadians in North American dental schools has not decreased but has actually increased over the last five years. Also, since there is a significant number of Canadians studying dentistry in the United States, there will probably be increased pressure to change the policies of the National Dental Examining Board of Canada presuming that these Canadians will return home. Further data is presented which leads to the conclusion that the proportion of admitted students who graduate as dentists has remained fairly constant over the study period.

Canada↗
PubMed1988

The impact of the differences in the decline of dental school applicants in the United States and Canada.

The number of individuals writing the Canadian Dental Association Dental Aptitude Test and the American Dental Association Dental Admissions Test for the first time is used as a measure of the number of new additions to the dental school applicant pool in each of the past 15 years. Dramatic changes have occurred during that period. Comparisons are made and similarities noted between the situations in the United States and Canada. A discussion of the probable causes of the differences highlights the changing government programs in the two countries, the perceptions of potential applicants, and the attitudes of members of the dental profession. Some suggestions for future action are proposed.

Canada↗
PubMed1988

Curricular trends in North America.

Curricular changes in North America are at present being stimulated by changing disease patterns, changes in the needs of the patients attending dental schools, the desire to broaden educational experience without overloading the curriculum and overstressing the students. Curricula are changing in their content, their format, in the methodology used and in the targets that students are set. The evaluation of curricula and the planning of change are processes that are themselves undergoing revision.

Clinical Competence↗
PubMed1987

Phase I-II trial of high-dose epirubicin in patients with lymphoma.

High-dose doxorubicin has shown considerable activity in both previously treated and previously untreated patients with lymphoma. Because of the toxicities of doxorubicin at high dose, we elected to study a new anthracycline at doses comparable to doxorubicin at high dose, to assess response and toxicity. Epirubicin was administered at doses of 120 mg/m2, 150 mg/m2, and 180 mg/m2 every 3 weeks (maximum four doses) to groups of six patients with previously treated intermediate- and high-grade lymphoma. Sixteen of the patients had received significant prior therapy with an anthracycline and/or anthracenedione. At all dose levels, myelosuppression was severe, with median granulocyte nadirs less than 504/mm3. Hematological recovery occurred by day 21 at the 120 mg/m2 and 150 mg/m2 dose levels, allowing for the next cycle of therapy. However, at the 180 mg/m2 dose level, the majority of patients failed to have hematological recovery by the day of the next scheduled therapy. Forty-two % of patients (eight patients) had fever/neutropenia, and required antibiotics. One treatment-related septic death occurred (at 150 mg/m2). Alopecia (68%), fever immediately following treatment (63%), mild/moderate stomatitis (58%), and nausea/vomiting (53%) were the most common nonhematological toxicities. These toxicities were independent of the dose levels and were not dose limiting. A significant change (greater than or equal to 0.10) in the radionuclide ejection (EF) was seen in seven patients. The median of the entire group of patients fell from 0.63 to 0.56. No patient developed clinical or radiological evidence of congestive heart failure. A response rate of 58% (two complete responses, nine partial responses) was achieved with a median duration of 5 months (range, 1-15+). High-dose epirubicin can be successfully utilized in patients with previously treated lymphoma. The only dose-limiting toxicity observed at these dose levels was the lack of hematological recovery by day 21 with 180 mg/m2. Since epirubicin at high dose will be incorporated into high-dose anthracycline regimens in previously untreated patients utilizing a 3-week treatment cycle, 150-180 mg/m2 may be the maximally tolerated dose for such studies.

Adult↗
PubMed1987

Phase II study of aclarubicin in acute myeloblastic leukemia.

Aclarubicin is a new anthracycline antibiotic that produces substantially less cardiotoxicity in animals that does doxorubicin. Based upon prior Phase I and II trials in leukemia, a Phase II study in acute myeloblastic leukemia was developed to assess the response rate and toxicity in previously treated patients. Forty patients received aclarubicin 100 mg/m2 per day X 3 with repeated course on days 14-16 if marrow hypoplasia was not produced. Complete responses were achieved in 27.5% (11/40) with durations of 1.5, 2, 2, 2, 3, 3+, 4, 5+, 32+, 33+, and 34+ months. Toxic effects of this therapy included severe neutropenia and thrombocytopenia, nausea/vomiting, mucositis, and diarrhea. No patient developed significant changes in the left ventricular ejection fraction, as measured by radionuclide angiography, or any clinical cardiac symptoms. Alopecia was minimal. Aclarubicin can produce a significant response rate in previously treated patients with acute myeloblastic leukemia and should be considered for study in initial therapy.

Aclarubicin↗