Cancer natural therapy resource centre.
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Holistic Nursing↗
Biomedical subjects
S Hudson
Publications and source records attributed to S Hudson.
RDNS graduate nurse program in community nursing.
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Community Health Nursing↗
Part-time diploma offers maximum flexibility.
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Community Health Nursing↗
Reentry using naltrexone: one anesthesia department's experience.
The responsibilities of administrative managers may include dealing with the practitioner who is seeking to reenter the workplace while recovering from drug or alcohol addiction. The following article offers assistance when considering the development of a policy for reintroducing and monitoring these individuals in an anesthesia department. In this instance, naltrexone was found useful in facilitating reentry into anesthesia practice after inpatient treatment and while following a comprehensive aftercare program. The AANA Peer Assistance Advisors have compiled a model policy and reentry contract. For copies of policies, video resources, or other additional information, contact AANA staff member Susan Burger at (847) 692-7050, extension 3011.
Humans↗
Relationship of the antispasticity effect of tizanidine to plasma concentration in patients with multiple sclerosis.
BACKGROUND: Spasticity is a serious problem in multiple sclerosis (MS) and many patients do not achieve a satisfactory response to currently available oral antispasticity drugs. Tizanidine hydrochloride, an alpha 2-noradrenergic agonist, has been shown to have an antispasticity effect in single center trials of patients with MS. OBJECTIVE: To compare plasma concentrations of tizanidine with objective measures of muscle tone in patients with MS with moderate to severe spasticity. SETTING: Ten centers, all tertiary referral centers for the specialized treatment of patients with MS, in the United States and Canada. DESIGN: A randomized, double-blind, placebo-controlled, dose-response study of tizanidine hydrochloride (8 or 16 mg). PATIENTS: One hundred forty-two patients with spastic MS who were not taking any interfering medication, such as an antispasticity drug or other alpha-noradrenergic agonist, entered the trial. RESULTS: Tizanidine treatment reduced muscle tone significantly, as shown by improved Ashworth scores and increased knee swing amplitude recorded by the pendulum test, both of which correlated significantly with plasma concentration. Placebo had no significant effect on muscle tone. Dizziness, drowsiness, dry mouth, and fatigue were reported most often in the group treated with tizanidine at peak plasma concentration. CONCLUSIONS: Tizanidine reduces spasticity in MS, and both therapeutic effects and side effects are related to the plasma drug levels.
Adrenergic alpha-Agonists↗
Are community health interventions evaluated appropriately? A review of six journals.
OBJECTIVES: To determine if Randomized Controlled Trial (RCT) methodology was used appropriately in community health, we: (1) determined the proportion of non-randomized studies that should have been RCTs, and (2) assessed the quality of the RCTs. METHODS: The 1992 issues of six community health journals were manually searched. Intervention studies were analyzed. Studies that did not use randomization were analyzed for feasibility and practicality of RCT methods; RCTs were analyzed for quality using a checklist. RCTs were compared with community health RCTs from The New England Journal of Medicine. The proportion of studies meeting each criterion was determined. RESULTS: Fourteen percent of 603 studies were interventions and 4% were RCTs. Of those not using randomization, 42% should have. Mean RCT scores were significantly lower for the community health journals than for The New England Journal of Medicine. Many criteria important to quality scored poorly. CONCLUSIONS: RCTs are underused and lack methodologic rigor in community health. Conclusions regarding the effectiveness of interventions are therefore suspect.
Community Medicine↗
An evaluation of community pharmacy records in the development of pharmaceutical care in The Netherlands.
An electronic patient database linking prescribes with a Dutch community pharmacy consortium was evaluated in a subset of the population of Noordwijk (11,760 patients out of a total of 25,600). The pharmacy database (a file of 41 disease contra-indications representing a subset of the prescribers' medical diagnosis) was studied in order to assess its value for the accurate discrimination of target patient groups within the community and for support to the pharmaceutical care of individual patients. The aim was to examine the application of the pharmacy records to pharmaceutical care, tested by measuring the accuracy of the pharmacy database to predict the community public health profile; and, more specifically, the accuracy to identify three potential target groups for pharmaceutical care. The records of patients with angina, chronic respiratory disease and diabetes (n = 1116), representing 65% of the total pharmacy morbidity records, were studied in detail and verified by the files and texts of the prescriber's individual patient records. From samples of patients (n = 273) from the three patient groups, the extent and nature of co-morbidity, polypharmacy (drug entities prescribed annually) and drug therapy instability (prescription changes to dose or dose form annually) were characterised. Angina patients showed the most comorbidity, 46% having three or more additional diseases; chronic respiratory disease patients showed most drug therapy instability; and insulin-dependent diabetic patients received most polypharmacy per disease. The pharmacy database predicted the prevalence of 10 of 23 relevant disease categories (representing 51% of the total morbidity on the medical records). However, the prevalences of eight categories were underestimated and of five categories overestimated. Of the three patient groups, 73% of patients appeared on both the pharmacy and the medical database. Of the total co-morbidity recorded for these patients, 68% of records were common to both databases. The database discrepancies (32%) were due to morbidity omitted (12%) and morbidity unverified (10%) on the pharmacy database, together with morbidity omitted from the medical database (10%). The current pharmacy database provides a limited view of morbidity. A strategic approach to pharmaceutical care requires pharmacists and prescribers to verify and share patient information if patient groups and individuals within a group are to be usefully targeted.
Cardiovascular Diseases↗
Scenario analysis of the future of clinical pharmacy.
The role of clinical pharmacy in the health care system is changing rapidly. This change is almost universal among different countries and is related to developments in medical technology, health economics, informatics, socio-economic status, and professional relations. Transitions to new systems of clinical pharmacy are difficult to anticipate. Even with well defined targets, it remains uncertain what the future of clinical pharmacy will bring us. The construction of plausible scenarios may help us better in preparing for the 'new world' ahead. At the annual congresses of ESCP in Prague 1995 (24th) and Lisbon 1996 (25th), a number of scenario analysis workshops with respect to the future of clinical pharmacy were organized. This paper gives a report of the results of these scenario sessions and reflects on the implications for future policy making. After we identified the driving forces behind the future of clinical pharmacy, various sets of assumptions were made and from them scenarios were constructed which are plausible: they 'could' happen. This analysis provided a logical framework in which we ultimately depicted three alternating stories of the future of clinical pharmacy, named 'CLERK', 'CONTROLLER' and 'CARE MANAGER'. These scenarios are intended to help clinical pharmacists to break free of familiar mental maps and to stimulate creative thinking on the future.
Education, Pharmacy↗
An analysis of playground surface injuries.
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Accidental Falls↗
A descriptive analysis of children's playground injuries in the United States 1990-4.
OBJECTIVES: To review playground injury statistics over a five year period in order to develop an awareness of how and where children in the United States are being injured. METHODS: All data are based on the United States Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS) for playground related injuries during 1990-4. The surveillance data includes injuries recorded in more than 90 hospital emergency departments located throughout the United States. RESULTS: Each year there are roughly 211,000 preschool or elementary school-children in the United States who receive emergency department care for injuries associated with playground equipment. On average, 17 of these cases result in death. 70% of all injuries occur on public playgrounds, with nearly one third classified as severe. Swings, climbers, and slides are the pieces of playground equipment associated with 88% of all NEISS reported injuries. Falls to the surface are responsible for 70%. CONCLUSIONS: NEISS playground injury statistics contribute to our understanding of playground injuries. By identifying where and how children are injured, suggestions can be made in an attempt to make playgrounds safer.
Adolescent↗
An association between the heat-humidity index and preterm labor and delivery: a preliminary analysis.
OBJECTIVES: The goal of this study was to determine whether a relationship exists between heat-humidity indexes and rates of preterm labor and preterm delivery. METHODS: Preterm labor and delivery rates were compared during the 2 summer and 2 winter weeks with the highest and lowest heat-humidity indexes for each season. RESULTS: The rate of preterm labor increased consistently from 1.23% to 3.00% as the heat-humidity index rose. When preterm births were examined, the trend was similar but not statistically significant. CONCLUSIONS: Given the public health import of preterm labor and the frequency with which pregnant women may be exposed to extremes of heat, studies designed to confirm or refuse our preliminary observations are warranted.
Delivery, Obstetric↗
Strategies for weight control success in adults.
Recent evidence demonstrates that only about 5% of individuals embarking on a weight loss program show lasting weight reduction. While many weight loss strategies have demonstrated poor results, some combinations of approaches have been successful. Empirical evidence demonstrates that certain conceptual approaches can contribute to the development of strategies to facilitate weight loss. This manuscript addresses three conceptual approaches that direct intervention strategies. Cognitive-behavioral strategies are directed toward modification of eating behaviors, and the social-contextual approach is directed toward the social and partnership approach to intervention. Biophysical strategies that have demonstrated success in weight loss include the effect of dietary restriction and exercise on weight loss. Using this synthesis of empirical evidence for success in weight loss, practitioners can develop individually tailored intervention strategies for their clients.
Adult↗
The intracellular signaling pathways involved in MCP-1-stimulated T cell migration across microvascular endothelium.
The adherence and transmigration of T cells through microvascular endothelium is an essential step for recruitment into inflammatory lesions, although the factors that stimulate the directional migration of T cells have not been fully characterized. In the present study we investigated the capacity of chemokines to induce migration of T cells across dermal microvascular endothelial cell monolayer. The results showed that recombinant MCP-1 significantly induced transendothelial migration of both resting and activated T cells. Maximal induction of migration was observed at a concentration of 10 ng/ml and a 3- to 4-hr incubation period. In contrast, the chemokines IL-8, RANTES, and MIP-1 alpha failed to stimulate T cell migration at doses as high as 100 ng/ml. In studies designed to investigate the intracellular signaling pathways mediating the MCP-1 effect, the results showed that MCP-1 at doses ranging from 10 to 100 ng/ml did not cause an increase in intracellular calcium ions in T cells, even though this chemokine induced rapid calcium mobilization in monocytes. Furthermore, pretreatment of T cells with either bisindolymaleimide HCl, a specific inhibitor of protein kinase C, or genistein, a protein tyrosine kinase inhibitor, significantly decreased the MCP-1-induced transmigration in a dose-dependent manner. In contrast, T cells pretreated with the protein kinase A-specific inhibitor H89 responded normally to MCP-1 stimulation. Finally, T cell transmigration was inhibited by antibodies against CD11a, thereby confirming the importance of beta 2-integrin in the transmigration process.
Calcium↗
Does storage of sputum specimens adversely affect culture results?
It has been recommended that samples submitted for microbiological examination should be retained for 48 hours after issue of the final report. In order to ascertain whether reproducible results could be achieved following storage of sputum specimens, two laboratories each re-cultured 100 samples 48 hours after their report had been issued and a further laboratory re-cultured 100 samples 48 hours after receipt. Discordant results were obtained in only 5-25% of specimens, indicating that potential respiratory pathogens could survive storage.
Bacteriological Techniques↗
Hemoglobin damages the cultured endothelial cell monolayer from bovine cerebral arteries.
We demonstrated that hemoglobin reaches the endothelial layers by an immunoelectron microscopic analysis in a rabbit subarachnoid hemorrhage model. Next, the effects of hemoglobin on cerebral artery endothelial cells were investigated both morphologically and histochemically using a cultured monolayer from a bovine endothelial cell system. The cultured monolayer was incubated with six different concentrations of hemoglobin ranging from 0 to 10(-5) M for 24 hrs on two-chambered glass slides. The denuded area of the glass slide increased dose dependently while the intensity of the actin fiber decreased. Superoxide dismutase did not modify this change. In a preliminary study, the endothelial cell membrane showed a hemoglobin binding molecule (94.5k dalton). This study thus suggests that the effects of hemoglobin on the endothelial monolayer were partly caused by the direct binding of hemoglobin to the membrane.
Animals↗
Education cuts short sighted.
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Australia↗