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Biomedical subjects

M Kelly

Publications and source records attributed to M Kelly.

At least 433 records · Page 24Linked to original sources
PubMedDate not supplied

Counselling should be offered to people with end-stage renal failure.

Having a counsellor as a member of the multiprofessional team has made a positive contribution to the way in which people with end-stage renal failure manage their illness. This paper will show how families can be supported when someone close to them develops renal failure. A self-report questionnaire was sent to those who used the renal counselling service over a one-year period. Findings suggest that those who received a period of short-term counselling were able to cope more effectively with their illness and lifestyle changes and felt less stress as a result. The limitations of the evaluation will be discussed, however, we are not seeking to generalise our results but to describe our experience in our unit. This points to the value and necessity of having someone with the requisite skills, to offer people a place to talk about often difficult and painful emotions. In our professional opinion, all renal units should consider having a counsellor as part of an integrated approach to patient care.

Adaptation, Psychological↗
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Central nervous system monoamine neurotransmitter turnover in primary and obesity-related human hypertension.

Recent experiments in laboratory animals have challenged the conventional view that the dominant effect of CNS noradrenergic neurons in cardiovascular control is sympathetic nervous inhibition and blood pressure reduction, describing instead sympathetic activation. We have tested whether such a stimulant effect on sympathetic outflow is also evident in human hypertension. CNS norepinephrine turnover was estimated from the combined overflow of norepinephrine, MHPG and DHPG into the internal jugular veins. Cerebral blood flow scans allowed differentiation between cortical and subcortical jugular venous drainage. In patients with pure autonomic failure, jugular overflow of norepinephrine and metabolites was not reduced, indicating brain neurons and not cerebrovascular sympathetics was the source. In healthy men, CNS norepinephrine turnover and muscle sympathetic nerve activity were directly related (p < 0.02). Administration of the ganglion blocker, trimethaphan, caused a compensatory five-fold increase in jugular overflow of MHPG. Conversely, intravenous clonidine reduced CNS norepinephrine turnover by approximately 50%, this possibly representing a mechanism of drug action. In cardiac failure patients, sympathetic nervous activation was associated with a trebling of CNS norepinephrine turnover (p < 0.01). In untreated patients with essential hypertension, the sympathetic activation present was associated with 250% higher CNS norepinephrine turnover (p < 0.01), but in subcortical brain regions only. A close and direct relation exists between brain norepinephrine turnover and human sympathetic nervous activity. CNS release of norepinephrine, presumably in the forebrain where noradrenergic neurons are sympathoexcitatory and pressor, mediates increased sympathetic nerve firing in patients with essential hypertension.

Animals↗
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Hospice care in motor neurone disease.

Motor neurone disease is not automatically linked in people's minds with palliative care and the hospice movement, but an increasing number of people with the condition are benefiting from the services offered by hospices. The authors review what these services entail, and explain how they can help patients and families cope with this distressing illness.

Brain↗
PubMedDate not supplied

Nalbuphine sedation in a patient with long-term, high-dose chemotherapeutically controlled psychosis.

Consideration of which pharmacologic agent to use when a patient requires sedation prior to an oral surgery procedure entails a number of factors, including past medical history, current medications and dose level, duration of administration, pharmacologic interactions, and the dental needs of the patient. The case described in this report illustrates the importance of consideration of these factors in a patient who required sedation prior to oral surgery while taking 800 mg chlorpromazine, 300 mg amantadine hydrochloride, and 900 mg of cimetidine daily. The possible pharmacologic interactions which could occur from concomitantly administering either diazepam or a narcotic in the presence of these agents are numerous and significant. The choice of sedative agent was further complicated by the fact that the patient was prescribed chlorpromazine and amantadine in doses which far exceeded the usual therapeutic levels and had been maintained for an extended period of time, over 8 months. Consequently, any adverse reactions that may have resulted when sedating a patient taking chlorapromazine and amantadine hydrochloride in lower doses for a shorter duration would be more likely to occur with greater speed and severity in a patient receiving such high-dose, long-term therapy. Also, unusual reactions which have not been reported with usual therapeutic dose levels might also occur since these high doses approach toxic levels for some patients. Additionally, a sedative agent had to be used which would not interfere with the antipsychotic effects of chlorpromazine since the patient's psychiatric condition required maintenance of these unusually high therapeutic levels. The following case report gives the rationale and outcome of utilizing nalbuphine for obtunding pain and producing sedation during an oral surgery procedure under such complex therapeutic conditions.

Amantadine↗
PubMedDate not supplied

[Environment, patient information, and organization in a pediatrics urodynamics unit].

OBJECTIVES: Urodynamic studies require patient cooperation, and this can be difficult in the pediatric age due to their invasive nature. Our aim was to assess the benefits of organization, facility design and information specifically adapted to children. METHODS: We describe the facility design and organization of the Urodynamics Unit at the Children's Hospital in Boston. Environmental factors are adapted to the pediatric age and aim to reduce the impact of the examination. There are child's objects, images and toys in the examining room. Parents are allowed to be in the room while the test is performed, and music is played during the procedure. We describe the information pattern and the behavior of the nurses and physicians to preserve the child's privacy. An information leaflet and a survey on symptoms is sent to parents before the test. Information is adapted to every age and aims to reduce parental anxiety towards the test and make them understand the need for the study. There are two premises for information: 1) every procedure will be explained to the child and parents, and 2) they will be told the truth. RESULTS: An enhanced cooperation has been noted following these guidelines. Between 5 and 8% of the studies performed are not evaluable due to lack of cooperation from the patient and only two children have totally refused the test in the last two years (0.2%). CONCLUSIONS: Cooperation among urologists and specialized nurses as well as attention towards the child's and parents' psychological factors can enhance the diagnostic yield of this test.

Adolescent↗
PubMedDate not supplied

An interview with Moira Kelly. Interview by Patricia Patterson Hines.

The cardiac intensive care unit at the UCLA Medical Center was recently involved in a work restructuring process that included the introduction of patient care partners for professional nurses, and the redesign of select core processes, such as documentation. Moira Kelly, RN, a staff nurse on the unit, describes the challenges and rewards of work restructuring, including the relationship between the nursing professionals and the patient care partners.

Coronary Care Units↗
PubMedDate not supplied

Mind and body.

Explore the source record for details and available documents.

Body Image↗
PubMedDate not supplied

Effect of perinatal lead treatment on morphine dependence in the adult rat.

The effect of perinatal lead exposure (at 300 and 1000 ppm in the maternal drinking water from conception to postnatal day 14) on the opioid withdrawal syndrome in adult offspring has been studied to assess if lead produces long term disruption of opioid systems manifested as altered morphine dependence. Dependence was induced in 50 day old rats by administration of morphine in osmotic mini-pumps implanted subcutaneously and delivering 5, 15 or 40 mg/kg/day. At postnatal day 55 an opioid withdrawal syndrome was precipitated by administration of naloxone (4 mg/kg i.p) and withdrawal behaviour scored over the next 30 min. Both objective (jumping, weight loss, weight of excreta, wet dog shakes, mouthing and face washing) and subjective (teeth chatter, ptosis, diarrhoea, irritability) measures were scored. 60 min after naloxone animals were killed and plasma corticosterone measured as a biochemical index of withdrawal. Morphine withdrawal scores and plasma corticosterone exhibited a clear dose relationship and there were no significant differences between 0 and 300 ppm lead-exposed groups. However withdrawal scores in 1000 ppm lead-exposed animals were lower in 15 and 40 mg/kg morphine treated rats, predominantly associated with lower weight loss, wet dog shakes and mouthing responses. Paradoxically corticosterone levels were elevated in the 40 mg/kg morphine dose group. The results support other evidence that perinatal lead exposure can induce disruption in opioid functioning which persists to adulthood and suggest a possible link between lead and opioid addiction.

Animals↗