Discharge planning in the tertiary health care setting.
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Centralized Hospital Services↗
Biomedical subjects
M Donnelly
Publications and source records attributed to M Donnelly.
CSF electrophoresis: an adaptation using cellulose acetate for the identification of oligoclonal banding.
An adaptation of cellulose acetate electrophoresis for studying concentrated cerebrospinal fluid is described. Two hundred and twenty-one patients have been studied, and the specificity for multiple sclerosis and sub-acute sclerosing panencephalitis is discussed. This has been positive for oligoclonal banding (OB) in 79% of patients with clinically definite multiple sclerosis.
Cerebrospinal Fluid Proteins↗
Toward a comprehensive methodology for resident evaluation.
The development of a useful system of medical resident evaluation over a two year period demonstrated that traditional measures used successfully in undergraduate medical education were less appropriate and acceptable than more complex measures designed to assess actual clinical performance. The greater cost, time involvement and personnel required by the more complex measures were shown to be partially offset by the greater utility and acceptability of the evaluative data provides. The feasibility of using skilled, non-medically trained personnel to minimize faculty-physician time was demonstrated.
Clinical Competence↗
Longitudinal investigation of changes in interviewing performance of medical students.
The purposes were to determine the direction and extent of change in a medical student's ability to relate to patients between the sophomore and senior years, to assess the degree of predicted senior year performance from the sophomore year, and to determine the reliability of two major methods: interaction analysis (IA) and global faculty ratings. Twenty-two students were video-taped conducting two 10-minute interviews with a programmed patient: one as a sophomore, the other as a senior. The results for the interaction analysis method showed that the students were more directive, used more exploratory behaviors, were less supportive and more highly rated by the patients (actors) in the senior year. The physician-evaluators' global ratings indicated the students were more supportive, empathetic and open-ended, had fewer uncommon words, but conducted better overall interviews as seniors. The IA method was more reliable than global faculty ratings.
Aptitude↗
Energy metabolism in respiration-deficient and wild type Chinese hamster fibroblasts in culture.
This paper presents a comparison of energy metabolism in wild type and respiration-deficient Chinese hamster cells. From previous work (DeFrancesco et. al., '75) it was concluded that the mutant satisfies essentially all of its energy requirements from glycolysis and in this study we measure precisely the amount of glucose consumed and lactate produced per milligram increment of protein in exponentially growing cultures. From these measurements we calculate the amount of ATP derived from glycolysis (and hence the total energy requirement for normal proliferation) to be 105 +/- 15 mumoles ATP/delta mg protein in the mutant. It is 63 +/- 10 mumoles ATP/delta mg protein derived from glycolysis in wild type cells. We present evidence that the total energy requirement of wild type cells is similar to that of the mutant suggesting that approximately 40% of the energy requirement is derived from respiration. The oxidation of glutamine appears to be more significant than the complete oxidation of glucose to CO2 in these Chinese hamster fibroblasts. The amount of ATP required by the mutant cells per milligram increment of protein is relatively independent of pH.
Adenosine Triphosphate↗
Formaldehyde treated gelatin as a gel exclusion agent.
A high molecular weight fraction of gelatin precipitated from a solution of Difco gelatin with polyethylene glycol has several favourable properties in gel exclusion chromatography. To manufacture the gel exclusion agent, the gelatin was dissolved in hot water, allowed to set in the cold and rendered insoluble by reaction with formaldehyde. When finely disrupted and used as bed material in columns this gel is capable of separating protein components from mixtures of proteins of widely different molecular weights. Favourable properties include elasticity at relatively low concentration, its availability and its inexpensive nature.
Animals↗
Computing quality assurance costs.
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Costs and Cost Analysis↗
High dependency care: impact of lack of facilities for high-risk surgical patients.
BACKGROUND: The difference between the level of care available on general ward areas and intensive care units (ICUs) has resulted in the development of high dependency units (HDUs). AIMS: This study examined the current perioperative management techniques and clinical care settings of high-risk surgical patients in a hospital without a HDU. METHODS: A prospective audit of high-risk surgical patients was performed over an eight-week period. Using a pre-operative questionnaire, the anaesthetist categorised patient suitability for one of three post-operative care areas. In addition, desired and actual post-operative monitoring, pain management and organ support were indicated. RESULTS: Seven (25%) of 28 patients admitted to ICU were rated HDU suitable indicating inappropriate use of resources, while 27 (75%) of 36 patients admitted to the general ward were categorised as fulfilling HDU admission criteria. A total of 21/27 (78%) and 12/27 (44%) of this latter group had alteration of idealised post-operative pain management and haemodynamic invasive monitoring plans respectively. CONCLUSIONS: The absence of an intermediate care area facility in a tertiary hospital without an acute pain team impacts on the type of perioperative care provided to patients and the optimal use of resources.
General Surgery↗
Cutaneous reactions to thiacetazone in Zambia--implications for tuberculosis treatment strategies.
Tuberculosis in patients infected with human immunodeficiency virus (HIV) is a growing threat to public health in Africa. Thiacetazone, one of the continent's most widely used antituberculous agents, may lead to severe cutaneous reactions in the HIV infected individual. We describe the impact of this reaction on the tuberculosis (TB) control programme of a district hospital in Zambia in 1990, and examine the cost implications of changing the standard treatment regime. We carried out a retrospective survey of records of all patients beginning TB treatment in 1990, together with HIV test results and the cost of all treatments given. From this we derived estimates of costs of different regimes which are and could be used in TB control in Zambia. Severe reactions occurred in 18.7% of all HIV seropositive patients receiving thiacetazone, fatally so in 1.2% (odds ratio 16.6). The greatest part of the cost of the current regime is that attributable to the inpatient stay; we estimated that 29.4% of patients would be unable to receive drugs as out-patients but, even allowing for this, rifampicin-based regimes given to outpatients where possible would not cost more than the current strategy. We conclude that ethical and economic considerations support a change to rifampicin-based regimes in areas of Africa where HIV seroprevalence is high.
AIDS-Related Opportunistic Infections↗
Validation of rat endometriosis model by using raloxifene as a positive control for the evaluation of novel SERM compounds.
Approximately 10% of women of reproductive age suffer from endometriosis, a potentially painful disease process and important cause of female infertility. Raloxifene, a commercially available SERM (selective estrogen receptor modulator) compound, used for the treatment of postmenopausal osteoporosis, has preclinically demonstrated its estrogen antagonist effect on uterine tissue in rats. There is potential that SERM compounds may become a viable treatment option for human endometriosis, although more investigation is needed. In this study, raloxifene was administered at various doses to determine the efficacy and an appropriate dose level for use as a positive control in a rat model of endometriosis. Prior to dose administration, all rats underwent a bilateral ovariectomy, autologous transplantation of uterine tissue onto the peritoneal surface of the abdominal wall, and implantation of a subcutaneous estrogen pellet (E2). Two separate postsurgical experiments were performed. In experiment 1, following a 4-wk recovery, the rats bearing implants were assigned to three groups: (1) removal of the E2 pellet and dosing vehicle only (n = 7); (2) E2 and vehicle (n = 6); and (3) E2 and raloxifene at 10.0 mg/kg (n = 6). In experiment 2, also following a 4-week recovery, the rats bearing implants were assigned to five groups (n = 8/group): (1) E2 and vehicle only; (2) E2 and raloxifene, 0.3 mg/kg/d; (3) E2 and raloxifene, 1.0 mg/kg/d; (4) E2 and raloxifene, 3.0 mg/kg/d; (5) E2 and raloxifene, 10.0 mg/kg/d. All rats were dosed orally BID for 14 d. At the end of the study, the implanted endometrium was remeasured and compared to the pretreatment measurement. The results from both studies demonstrated that Raloxifene at only one dose (10.0 mg/kg) displayed significant implant regression (p < .05). Subsequently, our rat endometriosis experimental model consistently uses the exogenous E2 pellet and raloxifene at 10 mg/kg, BID, as a positive control to help screen and compare novel SERM compounds.
Animals↗
Comparative results of two intensive treatment programs for childhood acute lymphoblastic leukemia: The Berlin-Frankfurt-Münster and Dana-Farber Cancer Institute protocols.
We analyzed two of the most successful trials for childhood acute lymphoblastic leukemia, from the Berlin-Frankfurt-Münster group (BFM) and the Dana-Farber Cancer Institute (DFCI), to determine their similarities and differences and suggest ways to improve future treatments. Protocol ALL-BFM 81 (n = 611) was conducted between 1981-1983 in 37 centers in West Germany and Austria; Protocol DFCI 81-01 (n = 286) was conducted between 1981-1985 in seven centers within the United States. The BFM study used a risk score, based on peripheral lymphoblast count, liver size, and spleen size at the time of diagnosis to assign patients into one of the three treatment arms. The DFCI study classified patients into two groups: standard risk patients (age 2-9 years, with white blood count less than 20,000/mm3, and with no T-cell markers, mediastinal mass, nor central nervous system disease), and high risk patients (all others). Both studies involved intensive chemotherapy, although treatment strategies, cumulative drug doses and cranial radiation protocols differed. Study populations in the two trials were comparable with respect to age, sex, white blood count and proportion of patients with T-cell markers at the time of diagnosis. Using DFCI risk group criteria, 37% of BFM and 38% of DFCI patients were classified as standard risk. Median follow-up times were 6.8 years and 6.1 years, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Empowerment: an idea whose time has come in diabetes education.
We have learned much in the past 10 years about how to help patients to acquire diabetes-related knowledge and skills and how to use strategies to help patients change behaviors. However, the application of knowledge and techniques should be guided by a relevant, coherent, educational philosophy. Empowerment offers a practical conceptual framework for diabetes patient education. Empowering patients provides them with the knowledge, skills, and responsibility to effect change and has the potential to promote overall health and maximize the use of available resources. It is an idea whose time has come for diabetes education.
Diabetes Mellitus↗
The benefits of hypodermoclysis.
Hypodermoclysis (subcutaneous fluid administration) is a valuable means of replacing fluids and maintaining hydration for older people and palliative care patients. This literature review looks at three aspects of the therapy--client groups, wound care and types of infusion fluids.
Bandages↗
An ordinary life. The Northern Ireland experience.
The contraction of long stay psychiatric and mental handicap hospitals in Northern Ireland started later than in England and is proceeding more slowly. So far, the process appears to be a carefully planned one. Michael Donnelly and Nicholas Mays report.
Adult↗
A patient-staff group for long-term I.V. therapy patients.
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Fluid Therapy↗