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R Edwards

Publications and source records attributed to R Edwards.

396 records · Page 22Linked to original sources
PubMedDate not supplied

A clinico-pathological study of diabetic foot ulcers.

During a 32-month period 94 foot ulcers in 54 diabetic patients aged 38-90 years (mean 64 years) were managed in a specialist foot clinic. Fifty-six percent were men, and they were significantly younger than women; 46% were taking insulin. Mean duration of diabetes was 13.4 years. Comparison with controls revealed a higher prevalence (p less than 0.01) of retinopathy (60% vs 23%), neuropathy (89% vs 31%), vasculopathy (71% vs 34%), arterial calcification (31% vs 20%) and previous lesions (54% vs 4%). There was no difference in quality of diabetic control, or smoking habit. A simple classification of lesions was used. All types yielded mixed cultures of microorganisms (average 2.1 per swab); the flora obtained was affected by systemic antibiotics. Abnormal pressure was judged to have contributed to all lesions occurring in areas of callus. In addition definable trauma precipitated the event in up to 60% of all other types. Lesions in areas of callus were more likely to have healed by the end of the study period, but average time to healing was significantly longer than other lesions. Despite intensive outpatient support, 33 patients spent a total of 1188 days in hospital during the 974 day period, an average of 36 days per patient and 1.2 beds per day. Further research is urgently required to define optimal methods of prevention and treatment of diabetic foot ulcers.

Adult↗
PubMedDate not supplied

Comparative stability of meropenem against beta-lactamases from Bacteroides spp.

The activity of meropenem was similar to that of imipenem against 88 clinical isolates of Bacteroides spp., including 28 non-fragilis strains. Four of the isolates were able to hydrolyse cephamycins or penems. Investigation of beta-lactamases from these strains and 10 laboratory stock culture Bacteroides showed that meropenem and imipenem were degraded at a similar rate by cell-free preparations of these enzymes. Some of these strains were able to completely hydrolyse the carbapenems within 2 h. Despite this rapid hydrolysis, MICs of meropenem and imipenem for some of the strains remained within the susceptible range as judged by agar dilution titration.

Anti-Bacterial Agents↗
PubMedDate not supplied

Acute hypocapneic hypokalemia: an latrogenic anesthetic complication.

Hyperventilation of patients during surgical anesthesia is a common practice in the United States. The results obtained in the present study re-emphasize serum potassium concentration is directly proportional to arterial carbon dioxide tension, and that for every 10 torr decrease in PaCO2 there is a concomitant 0.5 mEq/L decrease in potassium. Therefore sudden and significant levels of hypokalemia may occur during the course of a general anesthetic, and since hypokalemia is known to be capable of producing serious cardiac arrhythmias, hyperventilation should be avoided during surgical anesthesia, particularly in patients on drugs which produce electrophysiologic changes similar to those resulting from hypokalemia.

Adolescent↗
PubMedDate not supplied

Donepezil overdose: a tenfold dosing error.

OBJECTIVE: To report toxicity resulting from donepezil administration following a tenfold dosing error. CASE SUMMARY: A 79-year-old white nursing home patient with a history of Alzheimer disease and hypertension was inadvertently given 50 mg of donepezil instead of her usual 5-mg dose. She presented to the emergency department with nausea, vomiting, and persistent bradycardia (HR in the 40s). Routine laboratory studies were all within normal limits. Basilar rales were noted five hours after arrival. She was treated with atropine 0.2 mg as needed for bradycardia (HR <50 beats/min); a total of 3.0 mg was administered over 18 hours. Each bolus kept her HR >60 beats/min for one-half to two hours. No further vomiting or evidence of pulmonary edema occurred after her initial episodes. She returned to baseline by day 2 (HR in the 70s) and was returned to the nursing home. DISCUSSION: Donepezil is a centrally acting, reversible cholinesterase inhibitor that is used in the treatment of Alzheimer disease. Donepezil is highly specific for neural acetylcholinesterases, preferentially binding acetylcholinesterase by greater than three orders of magnitude over butyrylcholinesterases. This specificity minimizes peripheral adverse effects at therapeutic doses. Our patient mainly experienced bradycardia and had minimal secretory effects compared with what is usually seen with nonspecific cholinesterase inhibition. Medication errors like the one that produced this overdose are a common but preventable cause of morbidity in healthcare facilities. CONCLUSIONS: A tenfold dosing error caused donepezil toxicity. The main effect of this overdose was bradycardia, which responded to atropine therapy.

Aged↗
PubMedDate not supplied

Randomized controlled trial of cost reductions from a health education program: the California Public Employees' Retirement System (PERS) study.

Purpose. This study evaluated the cost trend reduction from a health promotion program. Design. A randomized 12-month trial comparing claims data was conducted. Additional studies, utilizing quasi-experimental designs, analyzed changes in health habits and changes in costs estimated by self-report. Subjects. All active California Public Employees' Retirement System (PERS) employees (21,170), non-Medicare eligible retirees (8,316), and retirees with Medical Supplement coverage (25,416) administered by Blue Shield of California were included. Intervention. The program consisted of mailed health risk assessments at six- or 12-month intervals, with individualized reports and recommendation letters sent to participants emphasizing and encouraging change, self-management materials emphasizing self-care when appropriate, and quarterly newsletters. Passive participants received printed materials only. Measures. Health risks were based upon self-report; summary scores were computed by modified Framingham algorithms. Self-report cost data were estimated from reported doctor visits, hospital days, and days sick or confined to home. Claims data were those paid by Blue Shield of California. Results. The program was associated with: 1) reduction in health risk scores at 12 months, (p less than .001), 2) reduction of subject reported medical utilization from baseline (p less than .05), and 3) decrease in claims cost growth relative to controls (p=.03). Annual claims costs were approximately $3.2 to $8.0 million less than expected had costs for the experimental participants increased at the same rate as the control group. Discussion. Results suggest that appropriately designed health promotion programs can reduce health risks and at the same time reduce the medical care claims cost trend.

Age Factors↗
PubMedDate not supplied

Manganese neurotoxicity, a continuum of dysfunction: results from a community based study.

Excessive manganese (Mn) has been associated with neurobehavioral deficits and neurological and/or neuropsychiatric illness, but the level at which this metal can cause adverse neurotoxic effects, particularly with long-term exposure, is still unknown. The objective of the present study was to assess nervous system functions in residents exposed to manganese from a variety of environmental sources. A random stratified sampling procedure was used to select participants; persons with a history of workplace exposure to Mn and other neurotoxic substances were excluded. A self-administered questionnaire provided data on socio-demographic variables. Blood samples were analyzed for total manganese (MnB), lead, mercury and serum iron. Nervous system assessment included computer and hand-administered neurobehavioral tests, computerized neuromotor tests, sensory evaluation and a neurological examination. The present analyses include 273 persons (151 women and 122 men); MnB range: 2.5 micrograms/L-15.9 micrograms/L (median: 7.3 micrograms/L). Multivariate analyses were used and neuro-outcomes were examined with respect to MnB, taking into account potential confounders and covariables. Results were grouped according to neurofunctional areas and MANOVA analyses revealed that higher MnB (7.5 micrograms/L) was significantly associated with changes in coordinated upper limb movements (Wilks' lambda = 0.92; p = 0.04) and poorer learning and recall (men: Wilks' lambda = 0.77; p = 0.002; women: Wilks' lambda = 0.86; p = 0.04). Further analyses revealed that with increasing log MnB (Simple regression: p < 0.05) performance on a pointing task was poorer, frequency dispersion of hand-arm tremor decreased, while harmonic index increased, and the velocity of a pronation/supination arm movement was slower. An Mn-age interaction was observed for certain motor tasks, with the poorest performance observed among those _50 y and in the higher MnB category. Differences between genders suggest that men may be at greater risk than women, although effects were also observed in women. These findings are consistent with the hypothesis that Mn neurotoxicity can be viewed on a continuum of dysfunction, with early, subtle changes at lower exposure levels.

Adult↗
PubMedDate not supplied

Quantification of neuromotor function for detection of the effects of manganese.

The effect of low level exposure to manganese (Mn) was examined in 297 subjects from southwest Quebec. Blood manganese (MnB) levels as well as other possibly relevant variables were obtained. We tested equipment and analysis procedures that we have developed to quantify aspects of motor function thought to be affected by exposure to toxins, in particular, rapid alternating movements, rapid and precise pointing movements, and tremor. (1) The eurythmokinesimeter measures timing and precision of contacts between a hand-held stylus and a pair of metal targets (proximal/distal). This roughly approximates the finger-to-nose test of the UPDRS. Characteristics quantifying speed, precision and regularity of the movements were calculated, as well as multiple contacts due to tremor and an index based on Fitts' Law eliminating the effect of the trade-off between speed and precision. (2) The diadochokinesimeter accurately measures rapid rotation of the forearms (pronation/supination). Characteristics quantifying the range, speed, period, shape and regularity of the oscillatory movements were calculated, as well as the smoothness of the movement on a fine scale and the coordination between the two hands. (3) Postural tremor of the arm and hand was measured using the accelerometry-based "TREMOR" system of Danish Product Development. We used the amplitude and frequency characteristics provided by the TREMOR system: intensity, center frequency, dispersion and harmonic index. Previous studies have shown that these tests are sufficiently sensitive to detect small differences in performance of different groups of subjects, with indications that some characteristics are also specific to particular conditions. In this study, significant though small effects related to age and gender were found in many of the characteristics. When effects of other variables are removed, low-level exposure to Mn was found to be associated with a decrease in ability to perform regular, rapid and precise pointing movements, a decrease in ability to attain high maximum rotation speeds in rapid alternating movements, and an increase in regularity of tremor oscillations. Moreover, the effects are age-related for levels of MnB 7.5, micrograms/L.

Adult↗
PubMedDate not supplied

Indicators that count! Measuring population health at the community level.

We begin with a discussion of some vitally important conceptual and methodological issues. These issues concern our understanding of community, of health, of population health and its determinants, of the concept of 'measurement' and the values that underlie it, and our reasons for wishing to measure these constructs. We then present a framework for indicator categories, propose some criteria for indicator selection and suggest an initial set of core indicators. This indicator set reflects not simply health status--no matter how broadly defined--but also the environmental, social and economic determinants of health and the "healthfulness" of the community itself. Our most important conclusion is that if the information that is contained in the data of the indicator set is to be transformed into knowledge that can empower and emancipate the community, it has to be developed in consultation with the local community and local users of the information.

Canada↗
PubMedDate not supplied

Neuromotor profiles: what are they and what can we learn from them?

Eye movements, alternating movements, rapid pointing movements, and various tremors were measured on patients with Parkinson's disease (n = 21), on Cree subjects exposed to methylmercury (n = 36), and on healthy control subjects (n = 30). Neuromotor profiles were created according to thirty characteristics extracted from test results of four subgroups matched for age and composed of six subjects each. Z scores were calculated with respect to the mean and standard deviation of the control group for each of the 30 characteristics. The subgroup with the lower methylmercury blood level had larger z scores than the control subgroup and with a few positive values above one standard deviation. The subgroup with the higher methylmercury blood level had several z scores above two standard deviations. Interestingly, the abnormal values for the subgroup with Parkinson's disease were mostly limited to static tremor recorded with no visual feedback and reached up to 5 standard deviations. These results indicate that neuromotor profiles can be used to summarize information extracted from different neuromotor tests and to differentiate neurological conditions.

Eye Movements↗
PubMedDate not supplied

New syringe to prevent mechanical complications of central venous catheter placement.

Prompted by the continued frequency of mechanical complications associated with central venous catheter placement, a more effective and stable and safer catheter placement device has been proposed. Fifteen critically ill surgical patients who required central venous access for total parenteral nutrition (TPN) and fluid management had a central venous catheter placed using the new syringe technique. Despite an equipment-use learning curve, there was no equipment failure. In 14 patients, catheter placement was successful. In one dehydrated patient, repeated attempts at percutaneous infraclavicular subclavian access were not successful, but internal jugular vein access was gained. There were no mechanical or infectious complications in the 15 patients. The new syringe provides a stable platform, reducing the fumbling usual when disconnecting the needle from the syringe and thereby avoiding the potential complications of dislodgment or hub contamination of the introducer needle and air embolism.

Catheterization, Central Venous↗
PubMedDate not supplied

Mexican American and white American school dropouts' drug use, health status, and involvement in violence.

A group of Mexican American and white American school dropouts were compared with a control group and a group of academically at-risk students in three locations in the Southwest. The sample group consisted of school dropouts and comparison subjects in grades 6 through 12. Both comparison groups were matched with the dropouts by sex, ethnicity, and school grade. At risk students also were matched by age and grade point average. Dropout subjects were found to have the highest rates of alcohol and drug use, followed by at risk student subjects. The relative rates of use were about the same for nearly all drugs, with the largest differences found for drinking to intoxication and use of marijuana, uppers, and cocaine. Among the dropouts, 75 percent of Mexican American males and 90 percent of white American males had tried marijuana. More than a third of the dropouts had tried cocaine. One-third of the Mexican American males and more than half of the females in both the Mexican American and the white American group had tried uppers. Females, especially dropouts, had higher rates of tobacco smoking than males. The rates of cigarette smoking among dropouts were significantly greater than among the control group only for males. Health problems of parents were not related to dropping out of school for any of the ethnic or sex groups. However, dropouts were more likely to have had serious illness within the preceding year than members of the control group. Many dropouts live in a violent and dangerous world. As an example, about one in five dropouts had held a gun on someone in a confrontation, and 20 percent had cut someone with a knife. Nearly half had been badly beaten. Females were rarely perpetrators of crimes or misdemeanors, but were often victims. Forty-two percent of the white American female dropouts had been either raped or sexually assaulted. Mexican American females were found less likely to be victims of violence, which perhaps reflects cultural values of marianisma and machismo, involving protectiveness toward females.

Achievement↗
PubMedDate not supplied

Oncogene expression in vivo by ovarian adenocarcinomas and mixed-mullerian tumors.

Six-micron paraffin sections of paraformaldehyde-fixed specimens of 24 ovarian benign and neoplastic specimens were assayed for tumor cell-specific oncogene expression by a sensitive, quantitative in situ hybridization technique with probes for 17 oncogenes, beta-actin, and E. coli beta-lactamase. In the benign, borderline, and invasive adenocarcinomas, multiple oncogenes, including neu, fes, fms, Ha-ras, trk, c-myc, fos, and PDGF-A chains, were expressed at significant levels relative to a housekeeping gene (beta-actin). In the mixed-Mullerian tumors, a rather different pattern of oncogene expression was observed, characterized primarily by expression of sis (PDGF-B chain). For the adenocarcinomas, statistical analysis demonstrated that expression of several genes (fms, neu, PDGF-A) was closely linked to others (c-fos, c-myc) known to have important roles in the control of cell proliferation, but only one gene, fms, correlated very strongly with clinicopathologic features (high FIGO histologic grade and high FIGO clinical stage) predictive of aggressive clinical behavior and poor outcome. The authors discuss the role that tumor epithelial cell expression of the fms gene product might play in the auto- and paracrine control of growth and dissemination of ovarian adenocarcinomas.

Adenocarcinoma↗
PubMedDate not supplied

Hepatic trauma and amoebic liver abscess.

A patient with a history of severe trauma over the hepatic area followed 2 weeks later by a large amoebic liver abscess of the right lobe is described. The possible role of hepatic trauma in the genesis of liver abscess is discussed. A history of hepatic trauma should not distract the clinician from diagnosing an amoebic liver abscess when suggestive symptoms and signs occur.

Adult↗
PubMedDate not supplied

Human rights.

Explore the source record for details and available documents.

Human Rights↗
PubMedDate not supplied

Comparison of four cytologic sampling techniques in a large family planning center.

In recent years, several new cervical sampling techniques have been introduced to try to improve the accuracy of the cervical smear. In the present study four such techniques were compared: the Aylesbury spatula, Rolon spatula, Cervex device and Aylesbury spatula used in conjunction with a Cytobrush. The total number of smears collected was 14,172, 80% of which were from women under age 35. Despite large differences between the techniques with regard to the presence of endocervical cells in smears, no differences were found in the detection of dysplasia. Endocervical cells were seen significantly more often in dysplastic smears than in negative smears. There was little difference in the rate of unsatisfactory samples. It appears that in a young population, the instruments used for cervical sampling are not likely to significantly influence the detection of dysplasia if skilled personnel take the smears.

Adult↗
PubMedDate not supplied

Using qualitative research in community nurse casework.

This paper explores how methods and skills frequently employed in qualitative research can be used by community nurses to promote an interpretation of the setting that is valid and client-focused. It discusses the construction and use of casenotes, the development of theoretical sensitivity, employing native-language terms, and looks at the importance of a critical awareness of additional documentary evidence.

Community Health Nursing↗