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Biomedical subjects

P Irvine

Publications and source records attributed to P Irvine.

16 recordsLinked to original sources
PubMed1992

Deaths caused by physical restraints.

A retrospective analysis of 122 deaths caused by vest and strap restraints found that most victims were women (78%) and a median age of 81. Victims were found suspended from chairs (42%) or beds (58%); 83% were in nursing homes. Detailed analysis of 19 cases showed that all were demented, 13 had impulsive or involuntary movements, and 14 had recently tried to escape from a restraint or been found in a dangerous position while restrained. Restraints are an underrecognized, underreported, avoidable, and proximate cause of at least 1 of every 1,000 nursing home deaths.

Aged↗
PubMed1992

State regulations governing infection control issues in long-term care.

OBJECTIVE: To examine states' regulations governing infections and infection control in long-term-care institutions. DESIGN: Collection and examination of relevant documents from all of the states, the District of Columbia, the Joint Commission on Accreditation of Health Care Organizations, and Medicare/Medicaid. MAIN OUTCOME MEASURES: Rules governing (1) admissions of patients with infections, (2) tuberculin testing of residents, (3) employee health, (4) use of immunizations, (5) human immunodeficiency virus (HIV)-infected patients, and (6) infection control were compared. RESULTS: There were wide variations in states' policies in each of these areas and many were inconsistent with current scientific knowledge. CONCLUSION: Uniform federal standards for long-term care would probably provide a better and more economical way to ensure quality of care in these institutions.

Facility Regulation and Control↗
PubMed1991

Integrating HIV/AIDS policies and curricular content into baccalaureate nursing programs.

A model used by one school of nursing to implement HIV/AIDS policies, sequenced instructional opportunities, and a research-based evaluation process is described. In the evaluation phase, a study was undertaken to measure students' retention of HIV/AIDS knowledge and their application of universal precautions (U.P.). Findings revealed that 59% of junior baccalaureate nursing students and 75% of seniors retained knowledge about HIV/AIDS and U.P. Seniors indicated that in their role as nursing student or technician/extern, supplies and equipment were readily available and that they had sufficient time to implement U.P. However, only 64% admitted to following correct procedures, even though 96% acknowledged feeling confident in their ability to do so. Knowledge about HIV/AIDS and consistent application of U.P. protects nursing students, prevents legal problems, and promotes the quality of patient care.

Clinical Competence↗
PubMed1989

Circadian hematologic time structure in the elderly.

Twenty-three clinically healthy, diurnally active elderly subjects, 71 +/- 5 years of age were studied over a 24-hr span (six samples). Complete blood counts and differential counts were done (Ortho ELT-8, Wright stained smears). The circadian rhythm parameters of the hematologic variables in the elderly subjects were compared with reference values obtained from a larger group of clinically healthy young adult and adult subjects studied independently. The data were analyzed by cosinor and the Bingham test. Circadian rhythms in the number of circulating formed elements in the peripheral blood persist in the aged. In comparison with the young adult, the elderly subjects show differences in the timing (phase advance) of the circadian rhythms in circulating neutrophil leukocytes and lymphocytes, a decrease in the circadian amplitude of circulating platelets, a decrease in circadian rhythm adjusted mean (mesor) in the red cell count, and in the neutrophil band forms.

Aged↗
PubMed1988

An approach to the management of medical problems in demented patients.

The appropriate management of medical problems in demented patients plays an important role in maximizing their quality of life. Demented patients present medical problems differently and require treatment strategies that incorporate the strengths and weaknesses of the patients and their caregivers. The goals for treatment must be developed and followed in balance with any plans to limit the treatment because of the dementia.

Acute Disease↗
PubMed1982

Wide interpatient variations in gentamicin dose requirements for geriatric patients.

Substantial interpatient variations were demonstrated in the daily doses required to obtain therapeutic gentamicin sulfate serum concentrations in 417 elderly patients. Dosages ranged from 0.3 to 22.0 mg/kg/day in patients with a normal serum creatinine level. Twenty-five percent of these patients required daily doses higher than the standard regimen of 5 mg/kg/day, and 33% required less than 3 mg/kg/day. The drug half-lives in these patients ranged from 0.3 to 32.7 hours, compared with previous reports of 2.5 to four hours. The distribution volumes of these patients ranged from 0.07 to 0.53 L/kg, compared with reported values of 0.20 to 0.25 L/kg. These wide variations in kinetic variables in elderly patients and the need to obtain narrow ranges in serum concentrations required measuring serum concentrations and individually calculating each patient's dosage requirement early in the treatment course. Doing this consistently produced optimal peak and trough serum levels. Ototoxicity did not occur in any of the patients, and nephrotoxicity may have been drug related in 2% of the elderly patients.

Aged↗
PubMed1979

Tetanus and diphtheria immunity in urban Minnesota adults.

Tetanus and diphtheria antitoxin levels were measured in 183 urban adults, using a hemagglutination technique. Protective levels (greater than 0.01 unit/mL) of tetanus antitoxin were present in more than 85% of sera from all subjects under 40 years of age and from men between 40 and 59 years old. A minority of women (36%) between 40 and 59 years of age, and of men (41%) and women (29%) over 60 years of age, were protected. Less than one quarter of the study group had protective levels (greater than 0.01 unit/mL) of diphtheria antitoxin. The results of the study suggest that a minority of middle-aged women and older adults have been appropriately immunized against diphtheria and tetanus.

Adolescent↗
PubMedDate not supplied

Chronobiology of serum iron concentration in subjects of different ages at different geographic locations.

The circadian rhythm in serum iron concentration was studied in 61 elderly men (74 +/- 6 years of age) and 93 women (78 +/- 8 years of age) in Bucharest, Romania, in 81 clinically healthy boys and 103 girls (11 +/- 1.5 years of age) in Tîrgovişte, Romania, in 4 elderly men and 19 women (71 +/- 5 years of age) and in 75 young-adult men (24 +/- 11 years of age) and 52 women (24 +/- 9 years of age) in St. Paul, Minnesota, USA. Six samples were obtained from each subject around a 24-hour span. The sampling sessions in the elderly subjects in Romania and in the children extended over all four seasons. A circadian rhythm statistically verified by Cosinor analysis was evident in all groups in both locations. A statistically significant sex difference with lower circadian mean (mesor) and a lower amplitude in the women was found in the Romanian elderly subjects. The children in Romania showed no sex difference in any circadian rhythm parameters. The young adult subjects in Minnesota showed a significantly higher mesor and a phase delay in the men as compared with the women. The elderly subjects of both sexes at both geographic locations had a lower circadian mesor than the young adults and the children. In the Romanian elderly subjects also the circadian amplitude was lower, which was not the case in the Minnesotans. While the acrophase in the elderly subjects and in the children in Romania was comparable (0928 and 0932 local time resp.), the young adults in Minnesota showed in comparison to the Romanians a phase delay (1132 local time) and the elderly in Minnesota showed a phase advance (0732 local time) in comparison to all other groups. The latter finding will have to be confirmed by more extensive studies. In the elderly subjects in Romania the circadian rhythm in serum iron concentration was in phase with the circadian rhythms in total serum bilirubin and alkaline phosphatase but showed significant phase differences from the circadian rhythms in serum albumin, urea nitrogen (BUN), gammaglutamyl transferase (Gamma-GT), serum globulins, glucose, insulin and total serum proteins. The elderly subjects in Romania showed a statistically significant circadian phase delay in summer as compared to fall but showed no seasonal variation of the mesor. The children showed a circadian phase advance in fall as compared to the other seasons and a seasonal variation of their mesor with higher values in spring and summer as compared with winter and fall.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMedDate not supplied

Infection control practices in Minnesota nursing homes.

Because infection is a major cause of hospitalization among nursing home residents, we assessed infection control activities and related employee health policies in Minnesota nursing homes, using a questionnaire. The majority of institutions (378/440, 85.9%) responded. We found traditional isolation techniques were widely used, but blood and urine precautions were employed in less than half of the homes. Infection surveillance tended to focus on chart review. Antibiotic utilization studies were done in 76% of homes. Procedures for urinary catheter care were often at variance with current recommendations. Employee health policies required a physical examination of a new employee in a minority of institutions. Policies required by Minnesota statute (eg, skin testing for tuberculosis and documentation of employee illness) were carried out by most institutions. Infection control policies and procedures in nursing homes should be redefined so that, where appropriate, they are more consistent with practices in acute-care hospitals.

Aged↗