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Biomedical subjects

R Kirk

Publications and source records attributed to R Kirk.

54 records · Page 3Linked to original sources
PubMed1985

Experimental analysis of adherence counseling: implications for hypertension management.

A time series "reversal" design demonstrated that behavioral counseling increased medication adherence from about 60 to 100% for a black, hypertensive patient. However, inadequate pharmacological treatment yielded no clinically important blood pressure decrease. The combination of improved compliance and minimal blood pressure reduction led the patient's physician to explore higher doses and alternate medications to achieve blood pressure control. The physician's aggressive medical treatment was initiated only after the patient's compliance had been improved. Thus, this study suggests that paraprofessional counseling can increase compliance and illustrates the need for both behavioral and physiological data in clinical management to avoid blaming patients for poorly controlled blood pressure.

Adult↗
PubMed1984

Is coagulase-negative staphylococcal bacteraemia in neonates a consequence of mechanical ventilation?

The clinical symptoms associated with coagulase-negative staphylococcal bacteraemia in infants on a Special Care Baby Unit were investigated. They were compared with those of blood culture-negative controls matched for age and weight. Infants with positive cultures were further sub-divided by judging the isolate to be a contaminant or a pathogen. There was a high incidence of respiratory symptoms in the latter patients, particularly in infants of less than 37 weeks gestation. These symptoms often responded to antimicrobial chemotherapy, particularly in infants given correct antibiotics, as demonstrated by laboratory sensitivity testing. Bacteraemia was usually detected shortly after starting mechanical ventilation, and may be its consequence in premature infants. Gentamicin-resistance occurred in over 50 per cent of blood culture isolates of coagulase-negative staphylococci. We postulate that coagulase-negative staphylococci can be a neonatal pathogen requiring appropriate antimicrobial chemotherapy.

Coagulase↗
PubMed1984

The effects of lay counseling on medication adherence and blood pressure: adjunctive treatment for hypertension.

Ten noncompliant hypertensive patients were monitored and received counseling from trained aides. Monitoring and lay counseling was associated with a reduction of -10 mmHg in systolic blood pressure and of -7 mmHg in diastolic pressure (P less than 0.05). Medication adherence increased from 69% to 84%. Counseling resulted in pressure decreases equal to those obtained by usual care for similar but compliant patients. This analysis provides a model for paraprofessional adjunctive counseling of patients thought to be adhering poorly to their medication regimen, which may improve control of hypertension.

Blood Pressure↗
PubMed1983

Continuous ambulatory peritoneal dialysis in the physically disabled.

Continuous ambulatory peritoneal dialysis (CAPD) has been increasingly used as maintenance home dialysis by patients in end-stage chronic renal failure since it was first described in 1976. The procedure is hazardous in the physically disabled and blind and in non-compliant patients. This paper describes 2 patients, one with rheumatoid arthritis and the other with Volkmann's ischaemic contracture of the left forearm, who are able to carry out CAPD successfully with the aid of bioengineering.

Adolescent↗
PubMed1981

A simple and rapid method of washing and drying micro-titre plates used in ELISA.

A simple device constructed out of perspex sheeting and capable of washing 96-well micro-titre plates used in ELISA is described. It consists of three parts: (a) the 'shower' - a tank with 96 stainless steel syringe needles through which washing fluid runs into the wells of the micro-titre plate, (b) a sump into which washing fluid is collected and (c) a sliding base plate allowing the accurate positioning of the micro-titre plate below the shower. The efficiency of this washing device was established by comparing the results from several specific ELISAs with tha obtained after washing duplicate plates by hand. The use of a specially constructed centrifuge to spin-dry plates is also described.

Enzyme-Linked Immunosorbent Assay↗
PubMedDate not supplied

Managing the financial challenges of public-private collaboration.

With the growing emphasis on Medicaid managed care waivers as a method for states to constrain healthcare cost overruns (see also State Policy Review on page 63), new and creative pricing techniques for carve-out and carve-in programs will be a key to their success. The author builds on his experience in developing a Medicaid behavioral healthcare carve-out in Massachusetts to illustrate some basic principles in the pricing and management of such public-private collaborations. These collaborative systems should be based on specific actuarial models, plans for enhanced access to services and the need to change incrementally in the context of the political process.

Massachusetts↗
PubMedDate not supplied

Flexible scheduling.

Explore the source record for details and available documents.

Absenteeism↗
PubMedDate not supplied

The intramedullary compression rod.

The Kaessmann compression device was employed in 26 patients with fractures of the long bones. In 15 fractures of the tibia, prompt healing occurred, even in fractures in the distal one-fourth of the tibia. Most of these cases were treated without external plaster support, and were permitted early ambulation, with partial weight-bearing. The technique for immobilizing these fractures involves a sliding a Kuntscher nail over a tension rod, and then fixing the clevis of the tension rod to the distal bone fragments by a transverse screw. The Kuntscher nail is fixed to the proximal bone fragment by a metal lip, and after compression is achieved, a locking sleeve fixed by a screw to the tension rod, prevents loss of compression. In 11 cases of pseudarthrosis of the tibia, the medullary canal was enlarged by passing graduated drills down the bony canal, over a guide wire. The compression rod was then inserted across the pseudarthrosis, and seventy to 80 kg/cm2 pressure was applied to the bone ends. No bone grafting procedure was performed. In all 11 cases, prompt union occurred. Postoperative management was similar to that employed in the treatment of fresh fractures. Three success fusions of the ankle also attest to the effectiveness of this immobilization. Although controversy exists regarding the role of compression in the healing of fractures, the axial compression rod does overcome distraction, compresses the bony surfaces, immobilizing them securely to produce union with an economy of callus.

Ankle Joint↗