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Biomedical subjects

S A Murphy

Publications and source records attributed to S A Murphy.

At least 91 records · Page 5Linked to original sources
PubMed1981

Monitoring children on sustained-release therapy by salivary theophylline levels.

The serum-saliva theophylline level ratio was measured in 19 chronically asthmatic children after their conditions were stabilized on a sustained-release theophylline preparation. Simultaneous serum and saliva samples were collected at 0, 4, 6, and 10 hours after theophylline dose and measured by high-pressure liquid chromatography. The mean ratio for the group of 1.52 +/- 0.64 approximated the mean ratio from previous reports. However, the correlation coefficient (r = .80) was lower, and the interpatient and intrapatient variability (25% and 23%) much higher, than in previous reports. The possible mechanism of these findings in relation to sustained-release preparations are discussed. These data question the use of salivary theophylline determinations to monitor therapy. Dosage should be based on serum measurements.

Adolescent↗
PubMed1978

Immune-complex-mediated glomerulonephritis and pulmonary hemorrhage simulating Goodpasture syndrome.

Two female children whose clinical presentations and renal light-microscopic findings were consistent with Goodpasture syndrome are described. Immunopathologic studies demonstrated granular deposition of immunoglobulins and complement, suggesting that the renal disease was mediated by circulating immune complexes and not by anti-glomerular basement membrane antibody. Anti-GBM antibody was absent in both patients. These patients represent the first report in children of idiopathic nephritis due to immune complexes with associated pulmonary hemorrhage. The findings raise some doubt as to the accuracy of previous reports of Goodpasture syndrome in children, and also demonstrate the diagnostic and therapeutic importance of evaluation the renal immunopathology in the child with nephritis and pulmonary hemorrhage.

Anti-Glomerular Basement Membrane Disease↗
PubMed1978

Partial reversal of the cellular immune defect in common variable immunodeficiency with indomethacin.

We administered indomethacin (25 mg q.i.d.) to two patients with common variable immunodeficiency and measured the effect on their depressed cellular immune responses. The in vitro response of both patients' lymphocytes to phytohemagglutinin increased during indomethacin administration. Both patients were anergic to skin testing before treatment and responded to two of four skin tests during treatment with indomethacin. Thus indomethacin administration in vivo appears to enhance the cellular immune respone, paralleling its previously described effects in vitro.

Adolescent↗
PubMedDate not supplied

Towards optimal regimens of parenteral quinine for young African children with cerebral malaria: unbound quinine concentrations following a simple loading dose regimen.

Nine children with severe falciparum malaria were treated with an intravenous quinine regimen which did not require burettes or infusion pumps, to determine its practicability and to ensure that therapeutic drug concentrations were achieved and maintained throughout the dose interval. The regimen comprised quinine dihydrochloride (15 mg/kg; 12.5 mg/kg of the free base), which was added to a bag of intravenous fluid (after wastage of all but 100 mL), and given via standard giving sets over 2 h. Blood was drawn sequentially during the infusion, and for 12 h thereafter; plasma water was obtained by ultrafiltration of samples at the bedside, and quinine concentration was measured, in plasma and plasma water, by high performance liquid chromatography. Drug administration was practicable without burettes or infusion pumps; unbound drug concentrations exceeded the 99% inhibitory concentration for local parasites within 0.5 h, and remained within the therapeutic range for the entire dose interval. This loading dose regimen can now be recommended for young children in African hospitals; maintenance doses of 10 mg/kg should be given at 12 h intervals until oral antimalarial drugs are possible. These recommendations will need to be modified if susceptibility to quinine declines.

Child↗
PubMedDate not supplied

The disposition of intramuscular artemether in children with cerebral malaria; a preliminary study.

The disposition of intramuscular artemether (AM) was studied in 26 Kenyan children with cerebral malaria. Antimalarial activity determined by bioassay was compared with total plasma AM plus dihydroartemisinin (DHA) determined by high power liquid chromatography (HPLC). Therapeutic levels were achieved in most subjects (21/26) within 1 h of receiving intramuscular AM (3.2 mg/kg), with close correlation between bioassay and HPLC measurements (r = 0.706). However, there was marked inter-individual variation, antimalarial activity was undetectable in 5 subjects ('non-absorbers'), and plasma concentrations were lower in subject with respiratory distress. The 50% parasite clearance time was significantly longer in non-absorbers (mean = 13.1 h, SD = 10.8 vs. mean = 7.8 h, SD = 5.5; P = 0.013). We conclude that the bioavailability of intramuscular AM in children with severe malaria may be highly variable, particularly in the presence of respiratory distress, and may be associated with an inadequate therapeutic response.

Antimalarials↗
PubMedDate not supplied

Sources of occupational stress among firefighter/EMTs and firefighter/paramedics and correlations with job-related outcomes.

INTRODUCTION/OBJECTIVE: This paper reports the results of an initial effort to develop and test a measure of the various sources of job-related stress in firefighter and paramedic emergency service workers. METHODS: A 57-item paper and pencil measure of occupational stressors in firefighter/Emergency Medical Technicians (EMTs) and firefighter/paramedics was developed and administered by anonymous mail survey. RESULTS: More than 2,000 (50% rate of return) emergency service workers completed and returned the surveys. The responses of 1,730 firefighter/EMTs and 253 firefighter/paramedics were very similar in terms of the degree to which job stressors were bothersome. A factor analysis of replies yielded 14 statistically independent "Occupational Stressor" factors which together accounted for 66.3% of the instrument's variance. These Sources of Occupational Stress (SOOS) factor scale scores essentially did not correlate with a measure of the social desirability test-taking bias. Finally, SOOS factors were identified that correlated with job satisfaction and work-related morale of the respondents. Conflict with administration was the job stressor factor that most strongly correlated with reports of low job satisfaction and poor work morale in both study groups. CONCLUSION: The findings suggest that firefighter and paramedic job stress is very complicated and multi-faceted. Based on this preliminary investigation, the SOOS instrument appears to have adequate reliability and concurrent validity.

Adult↗
PubMedDate not supplied

The use of research findings in bereavement programs: a case study.

Violent death is a major public health problem in the United States, yet there is no consensus among bereavement researchers and clinicians regarding a "gold standard" of bereavement services to be offered to family survivors. This article has three purposes: (a) to describe the planning, implementation, and results of a theory-based intervention study involving parents bereaved by the violent deaths of their children; (b) to suggest programmatic elements of bereavement services based on some findings from both the bereavement program and the follow-up data obtained from parents up to 5 years postdeath; and (c) to identify future research and theory development needs. The results of the intervention study involving 261 bereaved parents provide helpful insights regarding parent bereavement program preferences as well as changes in parent outcomes. Some of the most relevant findings pertain to variability in distress levels, gender, and causes of deceased children's deaths. Findings suggest that many different types of services are needed to meet parents' needs. The follow-up data collected from the parents 1, 2, and 5 years postdeath demonstrate that loss accommodation following violent death bereavement is both lengthy and difficult. Recommendations follow for both bereavement services and research studies.

Accidents↗
PubMedDate not supplied

Parent bereavement stress and preventive intervention following the violent deaths of adolescent or young adult children.

It is currently believed that effective intervention programs can reduce the negative consequences of stressful life events. The purpose of this paper is to describe a three-step process used to develop a theory-based preventive intervention for parents whose 12- to 28-year-old children had died 2 to 7 months previously by accident, homicide, or suicide. Assumptive world, family life cycle, victimization, and social support theories form the basis for "matching" parent bereavement stress with selected intervention strategies.

Adolescent↗
PubMedDate not supplied

Parents' evaluation of a preventive intervention following the sudden, violent deaths of their children.

A preventive intervention for 156 bereaved parents whose 12- to 28-year-old children died by accident, homicide, or suicide was tested using a multisite longitudinal cohort pretest/posttest experimental design. Reported here are bereaved parents' evaluations of the two-dimensional support program. Problem-focused support was rated by parents' perceptions of readiness, relevance, timing, and understanding of the information and skills presented. Emotion-focused support was rated by the identification of I. Yalom's (1985) therapeutic group factors and group leader/clinician support. Over 70% of all the person/session responses showed that both support dimensions were rated at 6 or 7 on a 7-point scale (e.g., 0 = not at all relevant, 7 = very relevant.) Additional exploratory analyses examined the extent to which 5 participant and treatment characteristics influenced parents' evaluations. Clinical implications and future research directions are suggested.

Adolescent↗
PubMedDate not supplied

Parents' health, health care utilization, and health behaviors following the violent deaths of their 12- to 28-year-old children: a prospective longitudinal analysis.

Health status, health care utilization, and health behaviors of parents bereaved by the violent deaths of their adolescent and young adult children were examined 4, 12, and 24 months later. Participants were 261 bereaved parents (171 mothers, 90 fathers). About 20% of the parents reported "poor" physical health during the early bereavement period compared with 16% of Americans the same age. Over time, mothers' health improved whereas fathers' health deteriorated. Fathers in poor health compared with fathers in good health are 15 times more likely to report emotional distress and 4.6 times more likely to report trauma symptoms. Mothers in poor health compared with mothers in good health are 11 times more likely to report emotional distress and 3 times more likely to report trauma symptoms. Mothers' reports of physician visits and medication use were higher than fathers', however, mothers' rates for both decreased significantly over time whereas fathers' rates remained constant. Over 70% of the mothers and nearly 60% of the fathers practiced 2 or more health protective behaviors over time--a finding significantly associated with fewer stress-related illnesses, days absent from work, and non-productivity at work. Implications for the findings are discussed.

Adolescent↗
PubMedDate not supplied

Faculty development and curriculum change in substance abuse.

What approaches can be used to upgrade nursing education and clinical skills in alcohol and drug abuse? The authors discuss the development of faculty and curricula in three schools of nursing. The programs described are part of a national initiative to ensure that health care professionals have basic knowledge and clinical skills in screening, assessment, intervention, and the appropriate use of referral systems for clients with substance abuse problems.

Curriculum↗