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Biomedical subjects

M E Kerr

Publications and source records attributed to M E Kerr.

17 recordsLinked to original sources
PubMed1995

Evaluating cerebral oxygenation using jugular venous oximetry in head injuries.

When caring for the critically ill patient, a primary objective is to maintain an adequate delivery of oxygen to the tissues. Monitoring and ensuring satisfactory cerebral oxygen delivery in patients at risk for cerebral ischemia presents a significant challenge to the clinician. Cerebral oxygen content usually is determined using blood gas analysis, whereas blood flow to cerebral tissues is inferred from monitoring of the cerebral perfusion pressure. There is an assumption that cerebral oxygen delivery is adequate so long as the cerebral perfusion pressure exceeds 50-60 mmHg in the normal brain and the cerebral arterial oxygen content is normal. The cerebral perfusion pressure, however, is an estimated value calculated as the difference between the mean systemic arterial pressure and the intracranial pressure and provides merely an indirect index of the adequacy of cerebral oxygen delivery. The validity of the cerebral perfusion pressure as an index for cerebral oxygen delivery becomes questionable when the autoregulatory mechanisms of the brain are disturbed, as in severe head injuries. Jugular bulb oxygen monitoring provides a method of evaluating cerebral oxygenation status for early identification of impending ischemia by measuring oxygenation of the mixed cerebral venous blood. In this article, the authors review the physiology of cerebral oxygenation, describe a method of monitoring cerebral oxygenation using jugular bulb oximetry, and review a case study to show how these assessments can affect the nursing care of the head-injured patient.

Brain Chemistry↗
PubMed1995

Continuous bedside cerebral blood flow monitoring.

Continuous cerebral blood flow monitors are being used in critically ill neuroscience patients to assess blood flow in vulnerable regions of the brain and to evaluate the effects of treatments on these areas. Neuroscience nurses need to interpret cerebral blood flow values in relation to the many other physiologic parameters which are monitored in this population. Case studies are used to illustrate various patterns of regional blood flow in response to brain insults and therapeutics. Research implications of continuous cerebral blood flow monitoring are explored.

Adolescent↗
PubMed1992

Physical illness and the family emotional system: psoriasis as a model.

Most physical illnesses are characterized by significant variability in age of onset and severity of clinical course. Although many diseases may occur in the context of a strong family history for the disease, they may also occur when there is no such history. Psoriasis has been chosen as a model for demonstrating that variability in age of onset, clinical course, and family history for a given disease may be explained, in part, by factors related to the family emotional system, a concept described by family systems theory (Bowen theory). Links between the clinical manifestations of psoriasis and the family emotional system have important treatment implications.

Adaptation, Psychological↗
PubMed1987

Phase I study of TCNU, a novel nitrosourea.

TCNU is a chloroethyl nitrosourea based on the endogenous amino acid taurine. This paper reports its first evaluation in man. Eighty-four patients with refractory cancer received 12 dose escalations from 10-150 mg/m2 TCNU administered orally every 6 weeks. Clinical side-effects were predominantly gastro-intestinal but dose-limiting toxicity was thrombocytopenia. Pharmacokinetic monitoring with an HPLC assay sensitive to the nanogram range demonstrated unchanged TCNU in plasma for up to 8 h following administration. The mean half-life was 60 min. Clinical responses were seen in melanoma (four patients), lung cancer (two squamous, one small cell) and one patient each with renal and stomach cancer. These responses, together with the unusual pharmacokinetic profile of TCNU, warrant exploration in disease-orientated phase II studies at a recommended dose of 130 mg/m2 p.o. q 5 weeks.

Adolescent↗
PubMed1987

Mitoxantrone versus doxorubicin in combination chemotherapy for advanced carcinoma of the breast.

One hundred fifteen patients with metastatic carcinoma of the breast were treated in a randomized trial of mitoxantrone (Novantrone, Lederle Laboratories, Pearl River, NY) combined with vincristine and prednisolone (VMP) or doxorubicin (Adriamycin, Adria Laboratories, Columbus, OH) combined with vincristine and prednisolone (VAP). In 100 evaluable patients, the objective response rates were 35% for VMP and 61% for VAP, the complete response rates being 6% and 13%, respectively. In responding patients, median time to progression was 6.2 months for VMP and 7.9 months for VAP. The median survival whether measured from primary diagnosis, first metastasis, or from the start of chemotherapy was similar for both regimens. Toxicity, particularly alopecia, was appreciably lower in the VMP treated patients, but subclinical cardiotoxicity was seen within the scheduled dosage for both combinations. We conclude that VAP is clearly more active, but clinically more toxic than VMP. There is no survival advantage conferred by the more toxic combination. Cardiac toxicity is a potential hazard with either drug combination.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

Nursing effort and the exchanging human response pattern.

This descriptive, comparative study was done to determine the nursing effort required to treat actual and potential nursing diagnoses from the Exchanging Human Response Pattern in two patient care specialties: acute medical-surgical and postpartum. Patterns of diagnosis identification are described for the two groups, and differences in allocation of nursing resources (nursing effort) are examined. The sample included 200 observations (hospital days) for 50 patients: 33 postpartum patients, and 17 medical-surgical patients. Data were collected daily during the study period by nurses who provided direct care to the selected patients using an investigator-developed version of the Nurse-Patient Summary (NPS) nursing information and patient classification tool (Halloran, 1985). Potential nursing diagnoses received most of the nursing effort in the postpartum area (mean effort = 5.28), whereas actual nursing diagnoses in the Exchanging Human Response Pattern received a higher priority in the medical-surgical area (mean effort = 12.03). Statistically significant differences existed between groups in total nursing effort (t = -4.73, p less than .0001) and in nursing effort required to treat actual (t = -7.42, p less than .0001) and potential diagnoses (t = 3.99, p less than .0001) in the Exchanging Human Response Pattern. This study provides unique information about how nurses allocate their time to patients for the treatment of actual and potential nursing diagnoses, and outlines areas for further development in diagnosis-based patient classification.

Clinical Nursing Research↗
PubMedDate not supplied

Development of definitions for taxonomy II.

In the process of placing diagnoses into Taxonomy I, certain inconsistencies became apparent. Inadequate definition of both diagnoses and human response patterns, lack of defining characteristics, and inconsistency in the levels of abstraction within the taxonomic hierarchy made the task of assigning a diagnosis to a taxonomic pattern difficult. Ambiguity in the definitions of the nine patterns resulted in ambiguity in the basic foundation, which affected the entire structure. The Taxonomy Committee, before evaluating the current structure, had to make the following decisions regarding the current human response patterns: (1) Should the nine human response patterns be retained for further taxonomic work? and (2) If they are retained, what should be the first step in examining Taxonomy I-Revised? This second article in a series of four will familiarize the readers with the process and decisions by which Taxonomy II of the North American Nursing Diagnosis Association (NANDA) is evolving through the work of the Taxonomy Committee. This article also will identify the specific problems encountered in the development of Taxonomy I and Taxonomy I-Revised, and describe the steps establishing the validity of the process of formation of the nine human response patterns.

Classification↗
PubMedDate not supplied

Axes: focus of taxonomy II.

A number of persistent issues in the nursing diagnosis community have challenged the ability of one nursing diagnosis taxonomy to account for nursing's practice. The North American Nursing Diagnosis Association (NANDA) Taxonomy Committee, charged with the preparation of one taxonomy for all, has struggled with some of these issues and has initiated development of axes. The issues, figuratively speaking, become the axes. The axes are intended to describe the dimensions of the human condition. This article, third in a series of four, describes the process and development of the proposed axes.

Age Factors↗