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Biomedical subjects

M A Lewis

Publications and source records attributed to M A Lewis.

At least 271 records · Page 15Linked to original sources
PubMedDate not supplied

Wetland plant seedlings as indicators of near-coastal sediment quality: interspecific variation.

The toxicities of whole sediments collected from an urbanized Florida bayou-estuary were determined for the epibenthic mysid, Mysidopsis bahia, and the infaunal amphipod, Ampelisca abdita. In addition, the phytotoxicities of the same sediments were evaluated using rooted macrophytes, Scirpus robustus Pursh and Spartina alterniflora Loisel. The results of the 24 bioassays conducted for 7-28 days, were compared for interspecific differences. Toxicity to the benthic invertebrate species was predicted to be likely in all cases, based on comparison to effects-based sediment quality assessment guidelines. However, acute toxicity was uncommon and occurred at only one of the six sampling stations. In contrast, several sediments were either significantly phytostimulatory or phytoinhibitory (P < 0.05) relative to a reference estuarine sediment. The results show the importance of considering interspecific variation and phytoassessment in contaminated sediment evaluations. Phytoassessment, the focus of this research, provided useful information that would have been missing if only the animal test species were used. For this reason, the phytotoxicity data base needs to be increased to better evaluate the relevance of most current contaminated sediment evaluations for coastal areas and also to determine the realism of proposed numerical sediment quality assessment guidelines and criteria.

Geologic Sediments↗
PubMedDate not supplied

Antibiotic prescription for acute dental conditions in the primary care setting.

To determine the pattern of antibiotic prescribing (source and type) for acute dental conditions in the emergency setting, a prospective cross-sectional study was undertaken of 500 consecutive new patients attending the examination and emergency clinic of the Cardiff Dental Hospital in May 1994. The source and type of antibiotics prescribed, the nature of complaint and type of antibiotic prescribed in the primary care and dental hospital setting were recorded. Antibiotic prescription was a feature of the treatment of 30% (149/500) of patients. The 60 patients who had received emergency treatment prior to attending the hospital emergency clinic had been prescribed a total of 14 different types of antibiotics; 41% of these patients had sought treatment from general medical practitioners. Antibiotics were frequently prescribed without generally accepted criteria and there was wide variation in prescribing. Overall, only seven different types of antibiotics were prescribed in the dental hospital setting. The use of second generation antibiotics was more common in general practice than in the dental hospital. The results suggest that many patients with dental pain may seek treatment from medical practitioners, prior to, or in place of, definitive dental treatment. In summary, rationalisation of antibiotic prescription and the provision of emergency dental treatment is needed.

Acute Disease↗
PubMedDate not supplied

Randomized clinical trial of the effect of semi-occlusive dressings on the microflora and clinical outcome of acute facial wounds.

This study investigated whether treatment with occlusive, hydroactive polyurethane dressings affects the microflora and clinical outcome of acute wounds. A randomized, controlled trial was performed on 60 patients with acute facial lacerations. Following primary closure, patients were provided with either a dry-gauze dressing or a hydroactive polyurethane dressing (Cutinova Thin). The wounds were assessed clinically and microbiologically prior to closure, then after 5, 28 and 56 days. The dressing, which was removed at day 5, was also sent for microbiological culture. Wounds treated with the polyurethane dressing showed improved comfort and contour (p < 0.04), less erythema (p < 0.03) and less potential for scarring (p < 0.01) at day 5. At day 28 and day 56, there were no significant differences in the clinical assessment between the test and control groups (p > 0.05). A total of 518 isolates were recovered from the patients during the study. Mean number of isolates and bacterial growth density were calculated in both groups. A similar range of microorganisms were obtained from both treatment groups with no clear difference in organism colonization. This study shows the potential usefulness of facial wounds as a human model for studying acute wound healing responses and anti-scarring therapy. While short-term, clinical benefits of occlusive dressings were evident in the management of acute wounds, these data clearly show that all studies of scarring following acute wounding should extend over at least 3 months post-injury to allow for spontaneous improvement to occur.

Adolescent↗
PubMedDate not supplied

Hospital discharge after ambulatory knee arthroscopy: A comparison of epidural 2-chloroprocaine versus lidocaine.

BACKGROUND AND OBJECTIVES: This prospective, randomized, double-blind study compares the efficacy of epidural 2-chloroprocaine and lidocaine for attaining hospital discharge criteria after ambulatory knee arthroscopy. We hypothesized that 2-chloroprocaine would facilitate earlier discharge than lidocaine. METHODS: American Society of Anesthesiologists (ASA) I and II patients were randomized to receive equipotent doses of epidural 3% 2-chloroprocaine or 1.5% lidocaine, both without epinephrine. Time to block resolution and discharge were compared between groups, along with the need for epidural reinjection, surgical times, and postoperative back pain. RESULTS: Twenty-seven patients completed the study, 13 in the 2-chloroprocaine group and 14 in the lidocaine group. The 2-chloroprocaine group was ready for discharge significantly earlier than the lidocaine group (130 +/- 17 min [range, 105 to 160] v 191 +/- 32 min [range 144 to 251]; P <.0001, 90% power). The lidocaine group required more epidural reinjections. Anesthesia-related side effects were similar in both groups. CONCLUSIONS: Epidural 3% 2-chloroprocaine without epinephrine is an advantageous choice for ambulatory knee arthroscopy. It enables readiness for discharge an hour sooner than 1.5% lidocaine, requires fewer reinjection interventions, and may reduce delayed discharge secondary to prolonged time to void. This clinical study shows the superiority of epidural 3% 2-chloroprocaine over 1.5% lidocaine for expediting hospital discharge after ambulatory surgery.

Adolescent↗
PubMedDate not supplied

Secondary data analysis: new perspective for adolescent research.

Adolescents are at high risk for preventable health problems, but realities of research funding and obtaining data from large samples make it difficult for many researchers to answer important questions. Secondary analysis of existing data sets is described as a reasonable alternative in spite of its limitations. Methods and available resources are identified along with suggestions for research priorities with adolescents.

Adolescent↗
PubMedDate not supplied

The Transnational Study on Oral Contraceptives and the Health of Young Women. Methods, results, new analyses and the healthy user effect.

The results of the Transnational Study on Oral Contraceptives and the Health of Young Women studies are reviewed, potential biases shown, and new analyses are presented. The initial finding was a slight increase in the risk of venous thromboboembolism (VTE) when users of third generation OC (containing the progestins desogestrel and gestodene) were compared with users of older (second generation) OC [odds ratio (OR) of 1.5; 95% confidence interval (CI) 1.0, 2.1]. In order to account for potential biases in the study, new analyses were performed. A quadratic spline technique comparing first users of OC with never-users found that risk of VTE is highest in the first year of OC use, but showed no difference between the two generations of OC upon adjustment. An analysis of a new dataset which now included full information on the past exposure history of all study subjects with a Cox regression model with time-dependent covariates produced an OR of 0.8 (0.5, 1.3) for the comparison of current users of third generation OC with current users of second generation OC. The results of the newer analyses with more refined techniques and with an enhanced dataset which includes data collected on the past exposures of all study subjects indicates that bias, particularly that introduced by healthy user cohorts, accounts for the results initially shown for VTE within the Transnational Study.

Adolescent↗
PubMedDate not supplied

Chronic stress and illness in children: the role of allostatic load.

OBJECTIVE: Recent studies of stress have highlighted the contributions of chronic psychological and environmental stressors to health and well-being. Children may be especially vulnerable to the negative effects of chronic stressors. Allostasis, the body's ability to adapt and adjust to environmental demands, has been proposed as an explanatory mechanism for the stress-health link, yet empirical evidence is minimal. This study tested the proposition that allostasis may be an underlying physiological mechanism linking chronic stress to poor health outcomes in school-aged children. Specifically, we examined whether allostasis would mediate or moderate the link between chronic stress and health. METHOD: To test the hypothesis that allostasis contributes to the relation between chronic stress and poor health, we examined household density as a chronic environmental stressor, cardiovascular reactivity (CVR) as a marker of allostatic load, and number of school absences due to illness as the health outcome in a sample of 81 boys. RESULTS: Structural equation modeling indicated that the mediating model fit the data well, accounting for 17% of the variance in days ill. CONCLUSIONS: Results provide the first evidence that CVR may mediate the relation between household density and medical illness in children. More generally, these findings support the role of allostasis as an underlying mechanism in the link between chronic stress and health.

Adult↗
PubMedDate not supplied

Randomized trial of a program to enhance the competencies of children with epilepsy.

A randomized, controlled trial was conducted in Santiago, Chile to test the impact of a child-centered, family-focused educational program for children aged 7-14 years with epilepsy and for their parents. The objectives of the program developed and pilot-tested in Los Angeles, California were to increase the children's knowledge, perceptions of competency, and skills related to dealing with seizures. Children in the experimental group (n = 123) and their parents separately attended four 1 1/2-h sessions and then met together at the end of each session to share learning experiences. Control children (n = 113) and their parents attended three 2-h sessions with a traditional lecture followed by question-and-answer format. All participants were pretested and then retested 5 months after completion of the educational intervention. Although there was some knowledge increase among children in the control group, the knowledge of children in the experimental group was significantly enhanced in a variety of areas related to management of their seizures and unnecessary restriction of their social and play activities. There was a significant increase in the self-perceptions of social competency of children in the experimental group. Children in the experimental group without serious behavioral problems also reported significantly better behavior after the intervention than did control children. There was no impact on children's disclosure of their diagnosis to friends and others.

Adolescent↗
PubMedDate not supplied

Impact of the Children's Epilepsy Program on parents.

A randomized controlled trial was conducted in Santiago, Chile to test the efficacy of the Children's Epilepsy Program, a child-centered, family-focused intervention developed and pilot tested in Los Angeles, CA, U.S.A., using a counseling model for parents of children with seizure disorders to help them (a) deal with their anger, resentment, and grief related to the loss of a normal child; (b) increase their knowledge about caring for their child; (c) reduce anxieties related to having a child with a seizure disorder; and (d) improve their decision-making skills. All parents were pretested and then retested 5 months after the educational interventions. Parents in the experimental group (n = 185) and their children separately attended four 1 1/2-h sessions and then met together at the end of each session to share learning experiences. Comparison group parents (n = 180) and their children jointly attended three 2-h lecture sessions followed by question-and-answer periods. Although parents' overall knowledge of epilepsy was relatively high initially, it improved considerably in both comparison and experimental groups. With regard to anxiety, at the 5-month evaluation, experimental group parents and mothers in particular were more likely than control parents to state that they were less anxious (p less than 0.001), and their anxiety, as measured by the Taylor Manifest Anxiety scale, was significantly reduced (p less than 0.01).

Adolescent↗
PubMedDate not supplied

Assessment of risk reduction strategies for the management of agricultural nonpoint source pesticide runoff in estuarine ecosystems.

Agricultural nonpoint source (NPS) runoff may result in significant discharges of pesticides, suspended sediments, and fertilizers into estuarine habitats adjacent to agricultural areas or downstream from agricultural watersheds. Exposure of estuarine fin fish and shellfish to toxic levels of pesticides may occur, resulting in significant declines in field populations. Integrated pest management (IPM), best management practices (BMP), and retention ponds (RP) are risk management tools that have been proposed to reduce the contaminant risk from agricultural NPS runoff into estuarine ecosystems. Field studies were conducted at three sites within coastal estuarine ecosystems of South Carolina (SC) from 1985 to 1990 that varied in terms of the amount and degree of risk reduction strategies employed. An intensively managed (IPM, BMP, and RP) agricultural treatment site (TRT) was studied for pesticide runoff impacts. From 1985 to 1987, there were minimal (some IPM and BMP) management activities at TRT, but from 1988 to 1990, TRT was managed using an intensive risk reduction strategy. A second unmanaged agricultural growing area, Kiawah (KWA), was also studied and compared with TRT in terms of pesticide runoff and the resulting impacts on grass shrimp (Palaemonetes pugio) and mummichogs (Fundulus heteroclitus). A third, non-agricultural, reference site (CTL) was used for comparing results from the managed and unmanaged agricultural sites. In situ toxicity tests and field samples of the grass shrimp populations were conducted at each site and compared in terms of survival and the effectiveness of current risk reduction strategies. Significant runoff of insecticides (azinphosmethyl, endosulfan, and fenvalerate) along with several fish kills were observed at TRT prior to the implementation of rigorous risk reduction methods. A significant reduction of in stream pesticide concentrations (up to 90%) was observed at TRT following the implementation of strict NPS runoff controls, which greatly reduced impacts on estuarine fish and shellfish. At the unmanaged KWA, continued impacts due to the runoff of these insecticides were observed, along with several fish kills. Additional monitoring indicated that gravid female grass shrimp populations from KWA had elevated levels of P-glycoprotein (P-gp), a multidrug resistance protein, which may transport various pesticides across cellular membranes. Comparison of field results with laboratory toxicity tests established that pesticide exposure was the primary cause of observed field impacts at each site. These findings clearly indicate the value of an integrated risk reduction strategy (BMP, IPM, and RP) for minimizing impacts from NPS agricultural pesticide runoff.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMedDate not supplied

Changing nurses' AIDS-related knowledge and attitudes through continuing education.

The purpose of this study was to determine the effects of an acquired immunodeficiency syndrome (AIDS) continuing education conference on nurses' knowledge and attitudes. Subjects in the study (N = 125) were participants in a one-day conference held at a major medical center in southern California. Content of the program included AIDS epidemiology and etiology, infection control, psychosocial and institutional support for health care workers, sexual history taking and counseling, attitudes toward risk behaviors and the major transmission groups, and legal and ethical issues. Subjects were pretested and posttested using a structured questionnaire that measured AIDS-related knowledge and attitudes, and satisfaction with the conference. Participants were retested 2 to 3 months after the conference. There were significant pretest/posttest differences in knowledge and attitudes that were retained on retest. Subjects with lower levels of knowledge made the greatest gains in knowledge. There was also a tendency for knowledge levels to increase between posttest and retest suggesting that subjects were continuing to learn. Participants indicated satisfaction with the conference speakers and content.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Bullying in nursing.

BACKGROUND: Current concerns about the need to improve the working lives of health service staff are well founded, and are receiving new impetus in current NHS human resource practice. However, the incidence of bullying in nursing would seem particularly problematic considering its effect on such a large proportion of the health service workforce. This article deals with a number of pertinent issues regarding what might constitute bullying and the growth of the phenomenon. In particular, the lessons we can learn in relation to its impact on patient care should be of concern. CONCLUSION: Ongoing research by the author is beginning to indicate that managerial and often union recognition and handling of such problems is frequently far from satisfactory. The article concludes with some suggestions for improvements.

Humans↗
PubMedDate not supplied

NVQs for managers.

Explore the source record for details and available documents.

Clinical Competence↗
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Parishes must complement professional elder care.

Studies indicate that for every person in a formal system of care in the United States, two are cared for informally. The current economic slump and projections of a substantial increase in persons needing assistance with activities of daily living point out the need for community organizational efforts to provide services for the frail. Historically, the Catholic Church has provided human services to vulnerable persons. The local church now provides many long-term care services. Fordham University studies have identified a number of parishes with successful programs and indicate that virtually all can do more. Successful parish programs are characterized by an institutional consciousness, personal leadership rooted in a supportive structure, clergy participation, formal record keeping, training and support of volunteers, ecumenical efforts, neighborhood involvement, and diocesan support. The parish church has special opportunities to unify spiritual, physical, and social aid to increase the sense of belongingness of frail persons. The Church must play a more decisive role in the provision of long-term care services.

Aged↗