Biomedical subjects
Publications and source records attributed to S McDermott.
Preparing the nursing staff is essential when implementing bedside computers. Realistically, all staff may not be trained before the clinical information system (CIS) goes "live," but resource personnel and the vendor can alleviate stressors associated with the change. Promoting the system early is vital to gain interest and support.
The health promotion needs of older people, including optimising quality of life in chronic illness, are inadequately represented in The Health of the Nation. Tertiary health promotion is an integral part of district nursing but must be enhanced through goal-oriented care and skills development. Service policies should ensure that older people have access to appropriate care to meet their rehabilitation and emotional needs.
OBJECTIVE: To determine the effect of HIV-1 infection on immunoglobulin (Ig) G and IgA antibody response and circulating antibody forming cell response to oral immunization with the B subunit of cholera toxin. DESIGN: Healthy UK volunteers, and HIV-1-positive UK and Kenyan volunteers at different clinical stages of HIV-1 infection received two oral immunizations. CD4+ T cells, serum beta 2-microglobulin and neopterin were measured as surrogate markers of disease stage, and correlated with immunization response. METHODS: Serum antitoxin IgG and IgA measured by enzyme-linked immunosorbent assay and antitoxin IgG, IgA and IgM antibody-forming cells detected by enzyme-linked immunospot assay at different times after two oral immunizations. RESULTS: UK HIV-positive volunteers (mean CD4+ T cell count, 52 x 10(6)/l) responded poorly to primary and booster immunization. HIV-infected Kenyans (752 x 10(6)/l CD4+ T cells) had a significant primary and booster antibody response, whereas those with a mean CD4+ T cell count 186 x 10(6)/l had an insignificant primary, but significant booster response. Two oral immunizations induced antibody responses in HIV-positive Kenyan groups (who may have prior immunity from exposure to environmental bacterial toxins) of similar or greater magnitude to healthy UK volunteers. CONCLUSIONS: Mucosal immunization may recall immune memory and be of benefit in early and moderately advanced clinical HIV disease. The findings have important clinical implications in that mucosally targeted vaccines are potentially useful in this group of patients.
Data reports from South Carolina's 92 independent school districts were used to calculate prevalence rates of mental retardation and learning disabilities among school-age children. These prevalence rates were 41.66/1,000 children enrolled for mental retardation and 33.21/1,000 children enrolled for learning disabilities. The 1980-1981 school year was selected because this was the last year in which disaggregated reports were submitted for placement in educable mental handicap (EMH), trainable mental handicap (TMH), and profound mental handicap (PMH) programs. Exploratory factor analysis and multiple regression analysis were used to explain school district prevalence rates of categorization of children into programs for mental retardation and learning disabilities. Results show that community SES and tax inputs explain 39% of the variation in prevalence rates and that these factors affect rates indirectly.
A multidisciplinary approach was used to select a bedside computer in a tertiary medical center's medical intensive care unit. Three committees were formed both by the medical center and the vendor: selection, configuration and implementation. A similar committee structure also existed with the vendor. The sets of committees formed a strong partnership to ensure a state-of-the-art system which would be easy to use and provide nursing staff with more time at the patient's bedside.
This prospective analysis assessed the risk of mild mental retardation (MMR) associated with low birthweight (LBW) in the Child Health and Development Studies. Scores of 50-70 on the Raven Progressive Matrices, a relatively culture-free test of cognitive functioning, were used to categorize MMR. At the age of 5, 13.8% of the 195 children with birthweights less than 2500 g (LBW) were MMR, whilst 4.2% of the 2293 children with normal birthweights (> 2955 grams) were MMR. After adjusting for confounders (maternal age, race, education, prenatal alcohol use, maternal conditions, and congenital anomalies), the relative risk of MMR for LBW was 3.4 (95% CI 1.2-5.4). For children aged 9-11, 7.7% of 194 LBW children were MMR, compared with 6.2% of the 2546 with normal birthweights; the adjusted relative risk for LBW was 1.2 (95% CI 0.7-2.0). Although a strong association between LBW and MMR was observed for both blacks and non-blacks at the age of 5, the association between birthweight and MMR was apparent only for blacks in the cohort of children aged 9-11. These findings suggest that race, a marker for environmental factors which were not measured in this study, may modify the LBW and MMR relationship.
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A computerized dental data recording system (DDRS) was developed for the New England Elder Dental Study to improve data quality and increase field staff efficiency. The DDRS displays video screens similar to traditional paper forms to record data on coronal and root caries, dentate and denture status, subacute bacterial endocarditis screening, gingival bleeding, calculus, and periodontal attachment level. DDRS provides facilities for date and exam-component time tracking, on-line contextual comments, random record retrieval, editing, data backup, and data output in various data formats. This study compared the DDRS with a paper-form system for data entry accuracy. Dental caries and periodontal disease measurement data from 38 subjects were recorded on paper forms and independently entered using DDRS. The DDRS identified 150 illogical data errors, 39 inconsistent data errors, 7 invalid data and 34 miscellaneous data errors. Four technicians with field experience using both paper forms and DDRS reported time savings using DDRS in the field. DDRS has the potential for additional time savings by minimizing the time for data coding, cleaning, and management. Results demonstrate that DDRS could improve the quality of oral epidemiologic data by mandating strict adherence to protocols, preventing errors, and increasing field efficiency.
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We conducted a quasi-experiment to evaluate the impact of a Medicare waiver which allowed the use of nurse practitioners (NPs) and physicians assistants (PAs) to deliver primary care to Massachusetts nursing home patients and removed the limits on the reimbursable numbers of visits per month. A carefully matched set of 1,327 Medicaid patients from 95 non-participating homes in the same areas of Massachusetts was compared to 1,324 Medicaid demonstration patients from 75 homes. Information came from specially designed record reviews and the Medicaid and Medicare information systems. Separate analyses were done for newly admitted cases and rollovers. Comparisons of quality of care suggested that the medical groups using NPs and PAs provided as good or better care than did the physicians in the control group. There were no differences in functional status changes or in the use of medications. The demonstration patients received more attention, as reflected in more orders written and an average of one additional visit a month. Demonstration patients showed higher scores on three of seven specially designed quality tracers, congestive heart failure and hypertension for both new administrations and rollovers, and new urinary incontinence for new admissions. Rollovers had significantly fewer emergency and total hospital days. A cost analysis suggests that the use of NPs and PAs saves at least as much as it costs and may save additional money with more sustained use.
A computerized nurse careplanning system (CNCP) was implemented on two nursing units of the Veterans' Affairs Medical Center, Washington, DC. This pretest, post-test experimental study sought to determine the effects of implementing this system on selected nursing care activities and associated patient outcomes. Effects on outcomes of job satisfaction, use of careplanning and competency of staff nurses were also examined. The sample consists of four medical nursing wards with registered nurses (n = 40) and patients (n = 160 as subjects). Data collection included nurse questionnaires, patient interviews and chart reviews. Results of the multiple regression analyses will be summarized here. Plans for further enhancement of CNCP will be discussed.
A record review and interview survey were carried out to determine the impact of injury on the health of male migrant workers in the Ridge area of South Carolina. Thirteen percent of the men's visits to the Rural Migrant Clinic were for injuries. A larger number, sixty percent, of men's visits to the local Emergency Room were due to injuries. Documentation of alcohol and drug use or the circumstances of the injury was more complete on the Emergency Room records than on the Clinic records. Interviews with 116 migrant workers were carried out in the camps during the summers of 1986 and 1987. Male migrant workers had similar rates of work related accidents as other hired farm workers in the United States. However, male migrant workers have more episodes of personal violence than black males living in other types of rural settings. Heavy drinking was associated with these violent episodes. Over 83 percent of the episodes of personal violence occurred in the camps after dark. It is suggested that camp conditions with poor sanitation, crowding, lack of recreational outlets, and high presence of available alcohol contributes to the high rates of injury in this group of men.
This study evaluated the impact of geriatric nurse practitioners (GNP) employed by nursing homes on quality of patient care and residents' outcomes during a 12-month study period. Quality of care was assessed in standardized interviews of 525 residents in five nursing homes with GNPs and 323 residents in five other nursing homes without GNPs. Each resident was interviewed up to four times during the study period (at baseline, and 3, 6, and 12 months later) to determine functional status, satisfaction with care, and physical condition at each of these points. The only significant difference between groups was that fewer newly admitted residents were hospitalized from GNP homes than from those without a GNP. The results of this interview study showed that the GNP as a nursing home employee had little impact on residents' functional status, physical condition, or satisfaction.
Stress and coping were examined in a sample of 30 rheumatoid arthritis (RA) patients and their 30 spouses. Two components of stress were measured: concerns and help needs. Results showed a significant agreement between patients and spouses on total concerns. The area of greatest concern for both groups was wondering about the future. The only help need that showed a significant difference between groups was diet and nutrition. Need for information about RA was the greatest need cited by both groups. Patients used significantly more coping strategies than spouses in dealing with RA-related stressors. Overall, cognitive restructuring was used most often by both groups. The study suggests that RA patients and spouses have similar concerns and help needs, and that while families may have lived with the RA for an extended period of time, health professionals should continuously assess concerns about the future and information needs in these families. The study results also suggest that spouses may need assistance in the use of effective coping strategies.
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A new challenge facing hospital management is the task of developing a close working relationship with physicians organized to effectively support managed care. How this challenge is met may play a pivotal role in the hospital's future.
Infections by Cryptosporidium were detected in association with clinical disease in 11 humans (Homo sapiens), 19 calves (Bos taurus), nine common quail (Coturnix coturnix), six mallard ducks (Anas platyrhynchos), five ring-necked pheasant (Phasianus colchicus) and a single budgerigar (Melopsittacus undulatus). Infections in mammals were accompanied by transient diarrhoea and anorexia, whereas infected birds exhibited clinical signs of respiratory distress. Repeated cross-transmission studies revealed apparent strain differences or differences in the host specificity of several mammalian and avian isolates for homologous vertebrate classes only. Oocysts from humans and calves were infective to mice, pigs or lambs, but not to chickens, whereas oocysts from quail and pheasant were infective to chickens, but not to mice.