Biomedical subjects
M McDonald
Publications and source records attributed to M McDonald.
A note on a quantitative method of recording cigarette smoking experience.
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The psychiatric evaluation of children.
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Falls in an acute hospital and their relationship to restraint use.
BACKGROUND: Patient falls are a common complication of hospitalisation. Use of restraints in patients who are perceived to be at risk for falling may lead to injury and even death. AIMS: To determine the frequency of falls and fall-related injuries and the contribution of restraints in a hospital population. METHODS: We analysed incident reports of falls for a single year from a large teaching hospital. Results The fall rate per 10,000 patient days was 13.2 (95%CI 11.6-14.8). Fall rate increased dramatically with increased age. Eighty-two (30.7%) falls resulted in injury, of which 6 (7.3%) were serious. Injuries occurred in 71/247 (29%) unrestrained falls and in 11/20 (55%) falls in patients who were restrained. Injuries were more severe in falls with restraints in place (p < 0.0001). CONCLUSIONS: Restraint use is associated with increased severity of injury in hospital patients who fall.
Assessment and management of cancer pain in the cognitively impaired elderly.
Cancer pain in the cognitively impaired elderly is a challenging problem for clinicians. Nursing and medical literature on the subject is sparse because the problem has not been adequately studied. This article presents strategies for assessment and management when the older adult has cancer and cognitive impairment. Traditional, pharmacologic, and alternative therapies are reviewed. Common etiologies for pain and confusion also are presented.
Medicare and the nurse. The peer review organization (PRO).
The PRO process is just one of the many reviews that HHAs are subjected to at any given time. On a practical level, HHA should incorporate PRO criteria and GQSs into its QA program. At present, there is no mechanism in place for denial of payment for substandard care, although proposed regulations were published in the January 18, 1989 Federal Register. Medicare certification, and therefore payment, could be lost if the facility or HHA were sanctioned. The Medicare law requires PROs to coordinate their activities with other review organizations. HCFA, however, has not established procedures for providing reports from fiscal intermediaries and PROs to the state survey agencies or coordinating state surveys with PRO reviews. HHAs should have structure and process criteria in place (either manual or computerized) to identify selected records for review. This enables the agency to monitor its internal quality assurance activities so that it has confidence that the GQSs will be met when reviewed by external agencies, including the PRO. This internal monitoring will also enable the agency to document patient outcomes. This is an important aspect of the evaluation process, since the emphasis of certification and accreditation programs and site visits will be focused on patient outcomes in the 1990s.
Contraceptives for feral cats.
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Automated lamellar keratoplasty.
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A CEO roundtable on making mergers succeed.
The announcement in January of the merger between America Online and Time Warner marked the convergence of the two most important business trends of the last five years--the rise of the Internet and the resurgence of mergers and acquisitions. M&A activity is at a fever pitch, spurred in large part by the breathtaking influx of capital into the Internet space. And all signs indicate the trend will only accelerate. Against this background, an impressive group of experienced deal makers came together to share their experiences of what makes mergers work. They were assembled in Scottsdale, Arizona, under the auspices of the M&A Group, a professional society formed in 1999 for CEOs interested in M&A as a business strategy. Participants included top executives from Internet start-ups like Teligent; venture capital firms like Baroda Ventures; financial institutions like Merrill Lynch and PricewaterhouseCoopers; and major corporations like Allstate, Tyco International, SmithKline Beecham, Rohm and Haas, VF, Crown Cork & Seal, and Hughes Space and Communications. The spirited and surprisingly frank discussion cut a wide swath, considering issues such as whether most mergers fail to pan out as well as expected, how to increase the odds of success, the nuts and bolts of the integration process, the trade-offs between acquiring a company and growing from within, the importance of cultural issues, and why anyone would want to be on the board of a merged company.
Rhesus incompatibility.
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Child health. Reducing fear in hospital.
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"Towards respiratory health".
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Admissions of injection drug users to drug abuse treatment following HIV counseling and testing.
The outcomes of counseling and testing programs related to human immunodeficiency virus (HIV) infection and risk of infection among injection drug users (IDUs) are not well known or understood. A counseling and testing outcome of potential public health importance is attaining admission to drug abuse treatment by those IDUs who are either infected or who are at high risk of becoming infected. The authors investigated factors related to admission to drug abuse treatment among 519 IDUs who received HIV counseling and testing from September 1987 through December 1990 at a men's prison and at community-based testing sites in Worcester, MA. By June 1991, 123 of the 519 IDUs (24 percent) had been admitted to treatment. Variables associated with their admission included a long history of drug injection, frequent recent drug injection, cleaning injection equipment using bleach, prior drug treatment, and a positive HIV test result. Logistic regression analyses, controlling for effects of recruitment site, year, sex, and area of residence, generally confirmed the associations. IDUs in the study population who were HIV-infected sought treatment or were admitted to treatment more frequently than those who were not infected. The results indicate that access to drug abuse treatment should be facilitated for high-risk IDUs and for those who have begun to inject drugs recently.
Traumatic laceration of the posterior tibial artery.
Traumatic laceration of the posterior tibial artery is an infrequent yet potentially devastating injury. Prompt diagnosis and treatment are necessary in order to limit ischemic damage to distal tissues. A case report is presented along with a brief overview of current surgical technique.
Galactosaemia--a controversial disorder. Screening & outcome. Ireland 1972-1992.
We reviewed 20 years (from 1972 to 1992) of screening for galactosaemia in Ireland. We looked at a small group of 32 patients followed up in the same centre since diagnosis. 1.2 million babies have been screened with 55 cases of classical galactosaemia and 7 Duarte Variants being detected. The frequency is thus, 1:23,000 and is increased among itinerants to 1:700. The mean age of diagnosis was 6.9 days with 41/62 cases symptomatic at the time. There were 9 deaths, 8 in the first 10 years, six of whom were itinerants. On follow up of the 32 children, who have attended Temple Street Hospital, 13/32 have no detectable complication. Nineteen show either one or a combination of cataracts, speech problems, tremors, abnormal FSH and or LH, delayed mental development and recurring infections. The screening test is the Bacterial Inhibition Assay with Beutler test, an original blood spot as confirmation in presumptive possible cases. The Beutler test is performed urgently in high risk situations. Five classical galactosaemics gave false negative results, 3 because of poor feeding, and two because of soya milk formulas. Screening prevented deaths as 7/84 siblings of our cases were unexpected infant deaths, all but one predating screening. Unexplained delay in screening undermines its effectiveness. Survival is enhanced by aggressive neonatal care. Symptoms are improved on commencing diet, with cataracts regressing. Complications did not correlate with the day of starting diet. Galactose-1-Phosphate and urinary galactitol levels did not correlate with complications, but slit lamp examination has proved a helpful index of adherence to diet. The mechanism of complications is unclear, and it is essential that current research should be aggressively pursued to explain mental deficiency in cases treated either pre-natally or early in post natal life.