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Biomedical subjects

S Hart

Publications and source records attributed to S Hart.

At least 127 records · Page 7Linked to original sources
PubMed1980

Surgical audit: Comparison of the work load and results of two hospitals in the same district.

Surgical audit is being undertaken to monitor and compare (by computer) the type of patient, work load, and results of two similar surgical units. Both units are in the City and Hackney District of London, one at St Bartholomew's Hospital and the other at Hackney Hospital. During 1978, 736 patients were admitted by the unit at St Bartholomew's Hospital and 902 by the unit at Hackney. At St Bartholomew's 70% of admissions were elective compared with 49% at Hackney, where 86% of patients lived within the district compared with only 36% at St Bartholomew's. The wound was the commonest site for complications, infection affecting 9% of those at Hackney and 6% at St Bartholomew's, despite identical antibiotic policies. There were six post-operative deaths at St Bartholomew's and 32 at Hackney. In both hospitals the length of stay was similar, 50% of patients being discharged within one week and 80% within two weeks. As a result of the audit a vigorous venous thrombosis prophylactic regimen has been instituted, and at Hackney the anaesthetic department has been strengthened and a new intensive care unit opened.

Adult↗
PubMed1980

Renal metabolism of paracetamol: studies in the isolated perfused rat kidney.

1. The metabolism of [3H]paracetamol has been studied in the perfused rat kidney. Seventy-four per cent of filtered paracetamol was reabsorbed. Paracetamol appeared in the urine; 90% was unaltered but 10% appeared as metabolites: the glucuronide, sulphate, mercapturic acid and cysteine conjugates. 2. At concentrations of paracetamol of 1--3 mmol/l no impairment of renal physiological function was observed. 3. The presence of the mercapturic acid and cysteine conjugates in the urine demonstrates the capacity of the kidney for oxidative metabolism of paracetamol and hence the formation of potentially toxic intermediates.

Acetaminophen↗
PubMed1979

A questionnaire for the examination of psychiatric liaison-consultation programs.

Liaison-consultation services have become an integral part of departments of psychiatry in medical schools and general hospitals. The evaluation of such services has focused most closely, thus far, on the efficacy of their educational programs. The author provides an extensive questionnaire which may be used for a global examination of the working structure of liaison-consultation services and recommends that liaison psychiatrists and personnel from the programs of other institutions be enlisted to participate in the process of evaluating programs.

Evaluation Studies as Topic↗
PubMed1978

Outcome for infants at high risk of major handicap.

Perinatal intensive care had been introduced in University College Hospital, London, by 1966. In the succeeding 10 years, 28-day mortality rates fell among infants of birth weight 1500 g or less. Among the survivors, the incidence of major handicap was 10% or less and the mean IQ increased to within the range expected for a normal population. Of the children aged 8 years or more 76% had no handicaps and were attending normal schools; 18% had minor handicaps or problems for which they were receiving extra help in normal schools; and only 6% were attending special schools. Throughout the 10 years of the study, the overall prognosis for these infants of very low birth weight improved significantly. Results among other high-risk groups were equally encouraging. Analysis of variance of the data from the infants who weighed 1500 g or less at birth indicated that perinatal complications, particularly illnesses associated with abnormal neurological signs or acidaemia in the infants around the time of birth, were the principal factors determining the condition of the survivors at follow-up. Thus, it is likely that additional refinements in the management of the perinatal period may result in further improvements in the prognosis of these and other high-risk newborns.

Achievement↗
PubMedDate not supplied

Severity of child maltreatment, pain complaints and medical utilization among women.

High medical utilization in adults has been linked to both reported history of childhood abuse and mental health problems. However, few studies have explored relationships between abuse severity and psychological distress to identify subgroups with unique utilization patterns and medical complaints. This study compared two groups of psychologically distressed, high utilizers. One group (DS) was comprised of those with psychological distress, who reported a history of child sexual abuse (CSA); the other group (DSP) consisted of those with psychological distress, who reported CSA plus a history of childhood physical abuse. The groups were compared on severity of sexual and nonsexual child maltreatment, medical complaints and medical utilization. From a convenience sample of 206 females age 20-63, recruited while waiting for a physician appointment in a primary care clinic, we compared 25 DSPs to 33 DSs. Compared with DSs, DSPs reported significantly more severe: (1) sexual abuse including completed intercourse; (2) emotional abuse; (3) emotional neglect; and (4) psychological distress. DSPs also showed a nonsignificant trend towards more severe physical neglect. In addition to being significantly higher on emergency room visits, DSPs were marginally higher than DSs on nonpsychiatric outpatient visits. DSPs had significantly more frequent chronic and acute pain complaints at emergency room (ER) visits. Headaches were the most frequently coded diagnosis at ER visits in this sample. DSPs accounted for 89% of these ER visits attributable to headaches. The interaction of psychological distress and reported severity of child maltreatment reveals subgroups with unique utilization patterns and medical complaints. Physicians should screen patients for child maltreatment severity and psychological distress and should be involved in mental health referral where necessary.

Adult↗
PubMedDate not supplied

Childrens' distress during burn treatment is reduced by massage therapy.

Before dressing changes, 24 young children (mean age = 2.5 years) hospitalized for severe burns received standard dressing care or massage therapy in addition to standard dressing care. The massage therapy was conducted to body parts that were not burned. During the dressing change, the children who received massage therapy showed minimal distress behaviors and no increase in movement other than torso movement. In contrast, the children who did not receive massage therapy responded to the dressing change procedure with increased facial grimacing, torso movement, crying, leg movement and reaching out. Nurses also reported greater ease in completing the dressing change procedure for the children in the massage therapy group. These findings suggest that massage therapy attenuates young childrens' distress responses to aversive medical procedures and facilitates dressing changes.

Anxiety↗
PubMedDate not supplied

Childhood sexual abuse, psychological distress, and medical use among women.

OBJECTIVE: This study examined the relationships between reported history of childhood sexual abuse (CSA), psychological distress, and medical utilization among women in a health maintenance organization (HMO) setting. METHODS: Participants were 206 women aged 20 to 63 years who were recruited from an HMO primary care clinic waiting area. Participants were classified, using screening questionnaires and the revised Symptom Checklist 90, as 1) CSA-distressed, 2) distressed only, 3) CSA only, or 4) control participants. Medical utilization rates were generated from the computerized database of the HMO for 1) nonpsychiatric outpatient, 2) psychiatric outpatient, 3) emergency room (ER), and 4) inpatient admissions. RESULTS: CSA-distressed and distressed only groups both used significantly more nonpsychiatric outpatient visits than CSA only and control participants but were not different from one another. CSA only and control participants did not differ on nonpsychiatric outpatient utilization. CSA-distressed participants used significantly more ER visits and were more likely to visit the ER for pain-related complaints than other participants. Among CSA-distressed participants, those who met criteria for physical abuse had significantly more ER visits than those who did not. There were no differences among the four groups in inpatient utilization rates. CONCLUSIONS: Psychological distress is associated with higher outpatient medical utilization, independent of CSA history. History of CSA with concomitant psychological distress is associated with significantly higher ER visits, particularly for those with a history of physical abuse. History of CSA without distress is not associated with elevated rates of medical utilization. Screening for psychological distress, CSA, and physical abuse may help to identify distinct subgroups with unique utilization patterns.

Adult↗
PubMedDate not supplied

Use of adhesion molecules for gene delivery.

Integrins are heterodimeric membrane glycoproteins important for interaction of cells with the extracellular matrix and with each other. However, integrins are also exploited as receptors by a number of bacterial, viral, and eukaryotic pathogens for cell binding and entry. This well-conserved pathway into the cell has now been exploited in the development of synthetic gene delivery systems for gene therapy. Peptides, such as the conserved arginine-glycine-aspartic acid (RGD) motif, provide convenient integrin-binding ligands for targeting polycationic complexes formed electrostatically with plasmid DNA. This review describes the development, advantages, and potential applications of such systems in gene therapy.

Animals↗
PubMedDate not supplied

Quality of life among mastectomy patients using external breast prostheses.

BACKGROUND: Most women who undergo mastectomy for breast cancer use external breast prostheses. Yet, little is known about patterns of use, satisfaction levels, and quality of life associated with their use as compared to other options. PATIENTS AND METHODS: We report longitudinal, self-report questionnaire data regarding prosthetic use from 592 Italian mastectomy patients. Women who report satisfaction with their prostheses are compared on medical, demographic, and quality of life variables to a matched sample of women who report dissatisfaction. We also compare matched samples of women who do not use prostheses and women who had reconstruction to prosthetic users. RESULTS: Most women used and were satisfied with their prostheses. However, there was a small group of women who were dissatisfied. These women reported greater disruption to their sense of feminility and worse quality of life in some areas. We found few differences between prosthetic users and women who used either of the other two options available following mastectomy-taking no action to restore the appearance of the amputated breast or having reconstructive surgery. CONCLUSIONS: No one technique for restoring the appearance of the mastectomized breast is necessary to optimize quality of life for all women. Physicians should describe the options to women, along with the average satisfaction rates for women choosing those options, and help women to make the best personal decisions.

Body Image↗