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Biomedical subjects

P Patterson

Publications and source records attributed to P Patterson.

At least 37 records · Page 2Linked to original sources
PubMed2000

Comparison of 4 analgesic agents for venipuncture.

This study compared pain on application, pain on venipuncture, cost, and convenience of 4 analgesic agents used for venipuncture. A convenience sample of 280 preoperative subjects was assigned randomly to 1 of 4 groups. Group 1 received 2.5% lidocaine--2.5% prilocaine cream (LPC) topically, Group 2 received dichlorotetrafluoroethane spray (DCTF), Group 3 received 0.5% lidocaine subcutaneously, and group 4 received normal saline with 0.9% benzyl alcohol (BA) subcutaneously. A 7-point verbal descriptor scale measured pain on application, and a 100-mm visual analogue scale measured pain on venipuncture. Cost was measured and compared on unit-dose basis. Convenience was measured with a questionnaire survey completed by the investigators. There was no significant difference (P < .05) among the groups for age, sex, ASA physical status, or difficulty of venipuncture. There was a significant difference in pain on application for all 4 agents (P < .05). The DCTF had the highest pain on application score (1.7 +/- 0.1), while the LPC had no pain on application (0.0 +/- 0). Lidocaine had a higher pain on application score (1.08 +/- 0.1) than the BA (0.52 +/- 0.1) but a lower score than DCTF. Lidocaine (1.3 +/- 0.3) was significantly less painful (P < .05) on venipuncture than LPC (2.18 +/- 0.3) and DCTF (2.5 +/- 0.3) but was not significantly different than BA (1.92 +/- 0.3). (All scores are given as mean +/- SEM.) There was a significant difference in cost and convenience among the 4 agents, with BA and lidocaine being the least expensive analgesic agents. Lidocaine, DCTF, and BA were equally convenient to use, while LPC was the least convenient, (P < .05). Lidocaine had low pain on venipuncture and low cost and convenience of use, but it was less than ideal in terms of pain on application. The BA had all the qualities of an ideal analgesic agent for venipuncture in this sample and should be considered as an analgesic agent for venipuncture.

Adolescent↗
PubMed1999

Summary report: evidence for the effectiveness of rehabilitation for persons with traumatic brain injury.

We evaluated the evidence for effectiveness of rehabilitation methods throughout the phases of recovery from traumatic brain injury (TBI) in adults. MEDLINE, HealthSTAR, CINAHL, PsycINFO, and the Cochrane Library were searched, and a total of 3,098 abstracts were reviewed. The strongest studies were critically appraised and their data placed in evidence tables. Results showed that to determine the effectiveness of rehabilitation interventions for persons with TBI, a commitment must be made to population-based studies, strong controlled research design, standardization of measures, adequate statistical analysis, and specification of health outcomes of importance to persons with TBI and their families.

Adult↗
PubMed1999

Effect of cognitive rehabilitation on outcomes for persons with traumatic brain injury: A systematic review.

We evaluated evidence for the effectiveness of cognitive rehabilitation methods to improve outcomes for persons with traumatic brain injury (TBI). A search of MEDLINE, HealthSTAR, CINAHL, PsycINFO, and the Cochrane Library produced 600 potential references. Thirty-two studies met predetermined inclusion criteria and were abstracted; data from 24 were placed into evidence tables. Two randomized controlled trials and one observational study provided evidence that specific forms of cognitive rehabilitation reduce memory failures and anxiety, and improve self-concept and interpersonal relationships for persons with TBI. The durability and clinical relevance of these findings is not established. Future research utilizing control groups and multivariate analysis must incorporate subject variability and must include standard definitions of the intervention and relevant outcome measures that reflect health and function.

Brain Injuries↗
PubMed1998

Prospective evaluation of an anemia treatment algorithm in hemodialysis patients.

Current guidelines recommend maintaining the hematocrits of chronic hemodialysis patients in the low to mid-30s. Maintaining patients' hematocrits within a narrow range requires frequent monitoring of their hematocrits and iron studies and periodic adjustment of erythropoietin doses and administration of intravenous iron. We designed a simple anemia treatment algorithm to streamline the management of anemia in hemodialysis patients. The protocol required formal monthly decisions about the administration of intravenous iron or changes in erythropoietin dose. This algorithm was implemented by dialysis nurses and evaluated prospectively for 6 months in a single dialysis unit (30 patients). The proportion of patients whose hematocrits were within the desired target (31% to 35%) increased from 27% at baseline to 61% during months 4 through 6 of the algorithm. Conversely, the proportion of patients whose hematocrit values were below the target decreased from 46% at baseline to 18% during months 4 through 6 of the algorithm (P=0.004). The percentage of patients whose hematocrit values were above the target did not increase. The proportion of patients whose transferrin saturation was less than 18% decreased from 47% at baseline to 20% during months 4 through 6 of the algorithm (P=0.04). The weekly erythropoietin dose administered decreased from 11,200+/-1,400 units at baseline to 9,400+/-1,200 units in month 6 of the algorithm (P=0.06). We conclude that a simple anemia treatment algorithm implemented by dialysis nurses is feasible and efficacious and may increase the proportion of hemodialysis patients whose hematocrit values are within the target range, without increasing erythropoietin requirements.

Adult↗
PubMed1998

Community based intervention on adolescent risk taking: using research for community action.

OBJECTIVES: To use research on adolescent risk taking behaviour as an impetus for a community to develop locally based injury prevention strategies. DESIGN: Case study, based on a community action model and formative evaluation. This involved: a community profile on adolescent risk taking behaviour; interviews with service providers; dissemination of research findings to local policy makers; development and implementation of a community action plan to address adolescent risk taking; and assessment of its impact. SETTING: A rural town with a population of 10,195 situated in the North Island of New Zealand. SUBJECTS: School aged adolescents and the safety policies and practices of community organisations involved with adolescents. RESULTS: Risk taking behaviours identified by the community profile included: drink-driving, substance abuse, carrying of weapons with intent to harm, and suicidal ideation. Community members identified that risk taking behaviour associated with alcohol in relation to: (1) violence (self directed and assault) and (2) road related injuries should be the focus of their activities. The strategies identified focused on advocacy, education, legal/regulatory change, and environmental modification. Evaluation conducted six months after intervention identified increased community awareness of the adverse effects of adolescent risk taking and some changes in policies and practice related to adolescent safety. CONCLUSIONS: Providing a community with local information that has high relevance for its members may act as a stimulus for the development of injury prevention initiatives. While this case study illustrated that a comprehensive approach focusing on adolescent risk taking behaviour, rather than on isolated injury problems, may be an appropriate way to highlight escalating adolescent injury rates, it also demonstrates the limitations of a short time frame for a community development project.

Adolescent↗
PubMed1998

Low serum antimycobacterial drug levels in non-HIV-infected tuberculosis patients.

BACKGROUND: Despite the use of directly observed therapy (DOT) by tuberculosis control programs, patient treatment failure, relapse, and acquired drug resistance remain problematic in a small number. We investigated serum drug levels in non-HIV-infected tuberculosis patients who were receiving DOT by the health department and did not respond to treatment as expected. METHODS: The indications for checking levels were as follows: (1) slow clinical response or failure to convert the sputum culture within 12 weeks; (2) treatment failure, early disease relapse < 13 months since being declared cured; (3) relapse, late disease reactivation > or = 13 months since being declared cured; and (4) acquired drug resistance while receiving DOT. Baseline characteristics of control subjects who responded to therapy as expected were compared. Venous blood for analysis was obtained at 2 h after directly observed ingestion and measured by high-performance liquid chromatography. RESULTS: Twenty-four patients receiving daily or twice-weekly standard therapy with isoniazid (INH, 300 or 900 mg) and rifampin (RMP, 600 mg) were identified; 22 had drug levels evaluated at 2 h. For INH, 15 of 22 patients (68%) had levels less than the reported target range. For RMP, 14 of 22 patients (64%) had low levels. Among the 14 patients receiving INH, 900 mg, and RMP, 600 mg, 4 (29%) had very low levels of both. Use of a combination INH/RMP tablet was associated with lower INH levels (p=0.04); however, RMP levels were higher (p<0.02). Alcohol use was associated with significantly higher RMP (p<0.01) serum concentrations. CONCLUSIONS: Important questions remain concerning the utility and timing of serum drug measurements. However, if a patient is not responding to therapy as expected and one is assured that the Mycobacterium tuberculosis organism is susceptible to the drugs given and that the patient is taking the medication as prescribed, drug level monitoring should be considered.

Adult↗