Search PubMed⌕ Search

Biomedical subjects

S L Moore

Publications and source records attributed to S L Moore.

At least 37 records · Page 2Linked to original sources
PubMed1993

Rational suicide among older adults: a cause for concern?

Society is collectively having to examine questions it has never had to face before and nurses are frequently confronted with the difficult issue of whether suicide can or should be a rational choice for older adults. They may be faced with the question of whether an older person should ever be restrained from suicide. Arguments for and against rational suicide are highlighted and the author makes the case for a rational approach to the affirmation of life, rather than its rejection, even to the very end.

Aged↗
PubMed1992

Catheter ablation of the atrioventricular junction using radiofrequency energy and a bilateral cardiac approach.

Radiofrequency current catheter ablation was used successfully to create complete atrioventricular (AV) block in 60 of 61 patients (98%) with drug refractory supraventricular tachyarrhythmias. The remaining patient developed Mobitz I AV block and is clinically improved (clinical efficacy 100%). In 54 patients (89%), complete AV block was achieved using a right-sided approach. Patients aged > 60 years needed significantly fewer right-sided radiofrequency applications to produce complete AV block (5.3 +/- 5.3 vs 11.1 +/- 10.0; p = 0.009). In 6 of 7 patients with unsuccessful right-sided ablation, a left ventricular approach was used. In each case, 1 to 4 additional radiofrequency applications produced complete AV block. Patients with unsuccessful right-sided ablation were generally younger than those with successful ablation (50 +/- 16 vs 64 +/- 11; p = 0.007). It is concluded that catheter ablation using radiofrequency current is an extremely effective means of producing complete AV block. Older patients appear to be more susceptible to right-sided radiofrequency approaches. Left ventricular ablation easily produces complete AV block in patients refractory to right-sided attempts.

Adult↗
PubMed1992

Analysis of deaths in patients with an implantable cardioverter defibrillator.

The cause of death and clinical characteristics of 26 patients that died after implantable cardioverter defibrillator placement were reviewed and compared to the 145 patients still living after a mean follow-up of 17 months. Operative mortality was 4% (7/171) and resulted from postoperative ventricular arrhythmias (four patients), heart failure (two patients), and respiratory failure (one patient). Operative mortality was significantly higher (1.7% vs 9.6%, P less than 0.05) following concomitant surgical procedures. Total late mortality was 11% (18/171). Thirteen deaths (75%) occurred in-hospital from progressive deterioration of left ventricular function (nine patients), arrhythmia (two patients), and noncardiac causes (two patients). Outpatient mortality was 3.5% (6/171) and resulted from presumed sudden cardiac death in five of six patients; two of the five had devices that were inactive, one had high defibrillation thresholds, and two had suspected bradyarrhythmic deaths. One postoperative death and one late in-hospital death were also considered sudden cardiac deaths for a total of seven patients with defibrillation system failures. By multivariant analysis, preoperative clinical characteristics associated with a worse prognosis following defibrillator implantation were identified: presentation as ventricular tachycardia (P less than 0.02), induction of sustained monomorphic ventricular tachycardia (P less than 0.05), poor left ventricular performance (P less than 0.01), poor functional status (P less than 0.001), and the use of diuretics (P less than 0.01). Frequent device discharges (P less than 0.001) and concomitant antitachycardia pacing systems (P less than 0.001) were markers for greater arrhythmia recurrence and were potent predictors of a worse prognosis and particularly sudden death.

Arrhythmias, Cardiac↗
PubMed1991

Implantable cardioverter defibrillator implanted by nonthoracotomy approach: initial clinical experience with the redesigned transvenous lead system.

Standard implantation procedure for the implantable cardioverter defibrillator (ICD) has traditionally required a thoracotomy approach. A newly revised nonthoracotomy defibrillator lead system that uses a single transvenous tripolar endocardial lead alone or in combination with a subcutaneous/submuscular patch lead was introduced into clinical trials in September, 1990. Fourteen patients requiring a cardioverter defibrillator for recurrent sustained ventricular tachycardia (eight patients) or aborted sudden cardiac death (six patients) were evaluated for implantation of this lead system. Primary successful lead system implantation was obtained in nine patients. The remaining five patients had unacceptably high defibrillation thresholds (DFTs) for implantation. One of the nine initially successful implants demonstrated unacceptable DFTs and cross-talk inhibition from a permanent pacemaker necessitating removal of the nonthoracotomy lead system and replacement with a conventional lead system via thoracotomy. All remaining primary implanted patients experienced successful conversion of induced ventricular fibrillation prior to hospital discharge. Continued follow-up and greater experience to confirm the durability and efficacy of the nonthoracotomy AICD lead system are needed.

Aged↗
PubMed1991

Rhythm disturbances after cardiac surgery.

The management of arrhythmias in the postoperative cardiac surgical patient often requires a combination of steps, correction of metabolic abnormalities, administration of antiarrhythmic agents, and precordial electrical shocks when necessary. Atrial, ventricular, or AV sequential pacing may also be required in conjunction with these other steps. Overdrive or underdrive pacing has also been used in the control and termination of various arrhythmias. In refractory arrhythmias, postoperative EPS can gear drug therapy more appropriately. In patients at increased risk of postoperative arrhythmias, preoperative EPS may identify these patients more readily. The placement of prophylactic ICD patches at the time of cardiac surgery in patients at increased risk can be performed safely and may obviate the need for subsequent thoracotomy. As clinicians, one should always be aware that any cardiac arrhythmia may occur following cardiac surgery, and that many modalities are available for their diagnosis and treatment.

Anti-Arrhythmia Agents↗
PubMed1990

The Neuman System Model applied to mental health nursing of older adults.

As we move into the 21st century, nurses are facing the challenge of contributing to the health care of a society with an increasing proportion of ageing persons. This group of people become more heterogeneous as they age, bringing with them an extended life history of experiences of wellness and illness. They have been faced with numerous stressors and losses and have made successful or unsuccessful adaptation to those life experiences. One of the disconcerting stressors of the elderly is the promotion and maintenance of mental health. In this paper we will examine the application of the Neuman System Model to the mental health nursing of older adults.

Adaptation, Psychological↗
PubMed1983

ECT for major depression in a patient with acute brain trauma.

A woman with depression and cerebral cortical laceration caused by a self-inflicted gunshot wound received ECT 3 weeks after wounding herself and had no untoward effects. The authors discuss relative contraindications to ECT based on head injury and posttraumatic seizures.

Adult↗
PubMed1982

Assessment of affect in schizophrenia. Reliability data.

Pathological affect--impairment of facial expressiveness and demeanor--is a common manifestation of the schizophrenic process. In this study, empirically defined and statistically independent concepts of affectual range, mobility, appropriateness, and communicability were rated by 30 professionals and paraprofessionals from special videotapes of 22 chronic schizophrenics. Reliability of the ratings, measured by correlations among and across parameters and rater types, averaged r = .70, notably better than that of the same raters using traditional subjective clinical judgment (r = .54). There was little disagreement among psychiatrists, psychology interns, junior medical students, or social workers/nurses, nor were any of those groups significantly more reliable than the average for all raters. Significant trends toward low reliability of the appropriateness parameter are pointed out and possible clinical relevance is discussed.

Adolescent↗
PubMed1980

Satyriasis: a case study.

Satyriasis is a term describing pathologic hypersexuality in males. A 24 year-old male presented with satyriasis. After a search for organic etiology proved unsuccessful, the patient was treated with medroxyprogesterone acetate and psychotherapy with good results. The differential diagnosis, psychodynamics, and treatment are discussed.

Adult↗