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Biomedical subjects

S Mitchell

Publications and source records attributed to S Mitchell.

At least 109 records · Page 6Linked to original sources
PubMed1994

Geropsychiatric nursing consultation: a valuable resource in rural long-term care.

Psychiatric and geropsychiatric nurse specialists have the potential to positively influence the day-to-day care provided in rural nursing homes by acting as teachers, resource persons, facilitators, and role models to long-term care (LTC) personnel. The combined approach of training LTC nurses to train their own staff while supporting the application of learning with consultee-focused nursing consultation proved to be an effective and time-efficient method of improving the geropsychiatric nursing care provided in rural nursing homes.

Aged↗
PubMed1994

Prevalence and first-line treatment of diarrhoeal symptoms in the community.

By systematically sampling patient registers in two socio-economically contrasting Scottish urban general practices, 440 households were selected and contracted by a research health visitor who interviewed a household member in 425 of them (response rate = 97%). Information was obtained on the point and period prevalence of diarrhoeal symptoms in all household members (n = 1,335), and on the knowledge, attitudes and behaviour of the respondents. While the point prevalence was low (under 1% of the household members), around 12% were reported to have experienced symptoms in the three-month period prior to the interview, and these were associated with a small but far from negligible loss of time from school or work. There were no significant seasonal differences in prevalence rates, nor were there significant differences between the two practices. Knowledge about appropriate treatment was high, but there was some confusion about the administration of liquids (especially milk) other than water, and a high level of ignorance about the existence and purpose of oral rehydration solutions. These findings have implications for public education about the initial management of acute diarrhoeal symptoms.

Adolescent↗
PubMed1994

Duration of antibody response after meningococcal polysaccharide vaccination in US Air Force personnel.

The long-term kinetics of the immunologic response after vaccination of adults with Neisseria meningitidis polysaccharide vaccine is unknown. Total meningococcal anti-capsular antibody response (measured by ELISA) and serum bactericidal activity after routine vaccination with quadrivalent meningococcal vaccine were evaluated in US Air Force personnel. In a retrospective cross-sectional study, blood samples were obtained from approximately 40 personnel before vaccination, at 1 and 4-6 months, and at 2, 3, 4, 6, 8, and 10 years after vaccination. Total anti-group A and -group C capsular antibody levels and bactericidal activity peaked 1 month after vaccination and declined substantially by 2 years. At each interval, significantly higher levels of total antibody and bactericidal activity were detected than before vaccination. Anti-capsular antibodies and bactericidal activity persisted for up to 10 years after immunization. These and further studies on the serologic measure of protection against meningococcal disease are important for evaluation of candidate vaccines and development of recommendations for immunization.

Adult↗
PubMed1994

Predicting outcomes after liver transplantation. A connectionist approach.

OBJECTIVE: The authors sought to train an artificial neural network to predict early outcomes after orthotopic liver transplantation. SUMMARY BACKGROUND DATA: Reliable prediction of outcomes early after liver transplantation would help improve organ use and could have an impact on patient survival, but remains an elusive goal. Traditional multivariate models have failed to attain the sensitivity and specificity required for practical clinical use. Alternate approaches that can help us model clinical phenomena must be explored. One such approach is the use of artificial neural networks, or connectionist models. These are computation systems that process information in parallel, using large numbers of simple units, and excel in tasks involving pattern recognition. They are capable of adaptive learning and self-organization, and exhibit a high degree of fault tolerance. METHODS: Ten feed-forward, back-propagation neural networks were trained to predict graft outcomes, using data from 155 adult liver transplants. The data included information that was available by the second postoperative day. Ten separate training and testing data subsets were prepared, using random sampling, and the ability of the different networks to predict outcomes successfully was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS: Four of the networks showed perfect discrimination, with an area under the ROC curve (Az) of 1.0. Two other networks also had excellent performance, with an Az of 0.95. The sensitivity and specificity of the combined networks was 60% and 100%, respectively, when using an output neuron activation of 0.6 as the cutoff point to decide class membership. Lowering the cutoff point to 0.14 increased the sensitivity to 77%, and lowered the specificity to 96%. CONCLUSIONS: These results are encouraging, especially when compared to the performance of more traditional multivariate models on the same data set. The robustness of neural networks, when confronted with noisy data generated by nonlinear processes, and their freedom from a priori assumptions regarding the data, make them promising tools with which to develop predictive clinical models.

Adult↗
PubMed1994

Observation of a reversible, medication-induced change in pitch perception.

This paper reports a study of an absolute pitch possessor who, upon administration of the psychoactive drug Tegratol (carbamazepine), experienced a significant change in her pitch perception. The subject's performance both in producing, as well as in identifying, random-frequency tones was measured, covering the period of administration of the drug, as well as control periods before and after. The main effect of the drug was a downward shift of the perceived pitch as compared to the two control periods. The magnitude of the shift was observed to increase with increasing fundamental frequency of the stimulus; the average shift was about one semitone. Detailed results on the frequency dependence and time dependence of the pitch shifts are presented. This may be the first documented report of a significant, reversible change of pitch perception caused by a medication.

Acoustic Stimulation↗
PubMed1994

Dichotic listening during auditory hallucinations in patients with schizophrenia.

OBJECTIVE: Auditory hallucinations are a serious problem for a large subgroup of psychotic patients who do not respond optimally to neuroleptic medication. It has been hypothesized that hearing imaginary voices involves the same physiological processes as those involved in hearing real voices, but this hypothesis has not been conclusively confirmed. METHOD: In this study a consonant-vowel version of the Dichotic Listening Test was used to assess the functional integration of the left hemisphere in hallucinating and nonhallucinating psychotic patients. The test was administered under three conditions: a nonforced attention condition, a condition in which attention was forced to the left ear, and one in which attention was forced to the right ear. RESULTS: The nonhallucinating patients showed the normal right ear advantage, which indicates a left hemisphere superiority in the processing of linguistic stimuli. In contrast, the hallucinating patients showed no ear advantage. Neither group was able to modify its performance when instructed to attend to either the left or the right ear. A subgroup of patients was tested in both hallucinating and nonhallucinating states, but the ear asymmetry was not noticeably different between these states. CONCLUSIONS: The results suggest that auditory hallucinations are associated with abnormalities in left hemisphere functioning and that these abnormalities might not be limited to the time of the auditory hallucinations. It is hypothesized that a relatively enduring left hemisphere abnormality may leave some patients at risk for auditory hallucinations.

Adult↗
PubMed1994

Too young to have a stroke.

This article tells of the author's experience of suffering a cerebrovascular accident (stroke) at the age of eighteen. The author's feelings, thoughts, and sensations are explored, as well as the psychological and physical effects of a stroke in both the acute and rehabilitation phases. Details are given of a support group started by the author to help other young survivors of cerebrovascular accidents.

Adaptation, Psychological↗
PubMed1994

Ways to promote successful training.

With today's financial cutbacks, long-term care facilities are looking for low-cost ways to help nurses meet licensing requirements. In-house training can be one economical way, but getting employees involved is another challenge.

Attitude of Health Personnel↗
PubMed1994

Selective vascular embolization in benign gynecologic conditions.

Eight patients with benign obstetric and gynecologic conditions required embolization. There was a total of 11 embolizations, and embolizing agents were chosen depending on the abnormality requiring embolization. Gelfoam, Ivalon and alcohol were used to treat vascular malformations. Ovarian veins were embolized with coils. Postoperative bleeding was managed with Gelfoam, coils and/or Ivalon. Four patients had bleeding after hysterectomy or vaginal suspension. One patient had postdelivery bleeding. All the bleeding was controlled after embolization. A uterine arteriovenous malformation was managed with embolization, allowing the patient to carry her next pregnancy to term. The symptoms of a vulvar hemangioma and ovarian syndrome were controlled with vascular embolization. Morbidity was minimal. Embolization is the primary treatment of choice in obstetric and gynecologic patients with postoperative bleeding or symptomatic vascular malformation.

Angiography↗
PubMed1994

Intravaginal misoprostol versus dinoprostone as cervical ripening and labor-inducing agents.

OBJECTIVE: To compare dinoprostone (prostaglandin E2) and misoprostol (prostaglandin E1) for ripening the cervix and inducing labor at term. METHODS: Sixty-three women were randomized to receive 100 micrograms misoprostol or 3 mg dinoprostone, both as intravaginal tablets. RESULTS: There was no statistical difference between the groups for pre-induction status. The mean Bishop scores before drug insertion were almost identical. Twelve hours after insertion, the mean change in the Bishop score was significantly higher in those receiving misoprostol (5.0 versus 3.3) (P = .008). However, there were no significant differences in induction-to-delivery interval, spontaneous labor rates, type of delivery, fetal outcome, or maternal complications. CONCLUSION: Misoprostol is as effective as dinoprostone for inducing labor at term.

Administration, Intravaginal↗
PubMed1993

Clinical and epidemiologic characteristics of hepatitis C in a gastroenterology/hepatology practice in Ottawa.

OBJECTIVE: To examine the clinical and epidemiologic features of hepatitis C virus (HCV) infection in a gastroenterology/hepatology practice in Ottawa. DESIGN: Retrospective chart review. PATIENTS: Sixty-three consecutive patients found to be anti-HCV positive. Their charts were analysed with respect to risk factors, history of hepatitis, serum aspartate aminotransferase (AST) levels and the presence of hepatitis B markers. The long-term sexual partners of 29 patients agreed to undergo HCV antibody testing. RESULTS: Of the patients 48 (76%) had been exposed to HCV parenterally: 27 used intravenous drugs, and 21 had received blood or blood products. Eleven patients did not have any known risk factor (sporadic infection), but eight of them had lived in countries where hepatitis C may be more prevalent; the other three had locally acquired infection. The mean serum AST level at the first visit was 140 (normally less than 40) IU/L. At least one hepatitis B marker was identified in 33% of the patients. None of the sexual partners who were tested were anti-HCV positive. CONCLUSION: Most cases of hepatitis C in Ottawa are acquired through parenteral exposure; sexual transmission is rare. Sporadic infection in the Ottawa region is rare but may be more common in people from countries with a higher prevalence rate of hepatitis C. Most cases of hepatitis C are asymptomatic.

Adult↗
PubMed1993

Problem-based learning: a review of literature on its outcomes and implementation issues.

The effects of problem-based learning (PBL) were examined by conducting a meta-analysis-type review of the English-language international literature from 1972 to 1992. Compared with conventional instruction, PBL, as suggested by the findings, is more nurturing and enjoyable; PBL graduates perform as well, and sometimes better, on clinical examinations and faculty evaluations; and they are more likely to enter family medicine. Further, faculty tend to enjoy teaching using PBL. However, PBL students in a few instances scored lower on basic sciences examinations and viewed themselves as less well prepared in the basic sciences than were their conventionally trained counterparts. PBL graduates tended to engage in backward reasoning rather than the forward reasoning experts engage in, and there appeared to be gaps in their cognitive knowledge base that could affect practice outcomes. The costs of PBL may slow its implementation in schools with class sizes larger than 100. While weaknesses in the criteria used to assess the outcomes of PBL and general weaknesses in study design limit the confidence one can give conclusions drawn from the literature, the authors recommend that caution be exercised in making comprehensive, curriculum-wide conversions to PBL until more is learned about (1) the extent to which faculty should direct students throughout medical training, (2) PBL methods that are less costly, (3) cognitive-processing weaknesses shown by PBL students, and (4) the apparent high resource utilization by PBL graduates.

Canada↗
PubMed1993

Intravaginal misoprostol as a cervical ripening agent.

OBJECTIVE: To determine if misoprostol (exogenous prostaglandin E1 PGE1) used vaginally was of value in improving the Bishop score, leading to an early safe vaginal delivery in women in whom the cervix is unripe and delivery is indicated. DESIGN: A double-blind clinical trial. SETTING: Antenatal and labour wards of the University Hospital of the West Indies, Jamaica. SUBJECTS: Forty-five women in the third trimester with various obstetric indications for induction of labour and with no contra-indications to prostaglandins. INTERVENTIONS: The women were randomly assigned to receive treatment or a placebo. The treated group had 100 micrograms misoprostol inserted vaginally while the placebo was similarly inserted. MAIN OUTCOME MEASURES: Efficacy of the misoprostol was measured by the increase in the Bishop score 12 h after giving the treatment, the time between insertion and delivery, the need for oxytocin, and the outcome of the pregnancy. RESULTS: The prostaglandin was superior to the placebo in ripening the cervix and inducing labour. The change in Bishop score was 5.3 in the misoprostol group compared with 1.5 in the placebo group (P < 0.001). The mean time from insertion to delivery was 15.6 h in the former while it was 43.2 h in the placebo group (P < or = 0.001). The need for oxytocin was also significantly less in the women receiving the prostaglandin compared with those who received the placebo (29% vs 62%, P < 0.02). There was no difference in the two groups in the delivery outcome in terms of complications, Apgar scores and mode of delivery. CONCLUSIONS: Intravaginal misoprostol is an effective and cheap method of inducing labour in the third trimester.

Administration, Intravaginal↗
PubMed1993

Randomized trial of FK 506/prednisone vs FK 506/azathioprine/prednisone after renal transplantation: preliminary report.

FK 506 was used as a primary immunosuppressive agent in 125 cases of renal transplantation in a randomized trial comparing FK 506/prednisone with FK 506/azathioprine/prednisone. With a mean follow-up of 5.5 +/- 2.5 months, there has been a 6-month actuarial patient survival of 99% and graft survival of 88%. There is no difference thus far between the two-drug and three-drug groups, although there may be less rejection and diabetes in the three-drug group. These results suggest that FK 506 is a useful immunosuppressive agent in kidney transplantation.

Actuarial Analysis↗
PubMed1993

Changes in perceived threats of shame, embarrassment, and legal sanctions for interpersonal violence, 1982-1992.

A survey conducted in 1982 measured perceived threats of shame, embarrassment, and legal sanctions for "physically hurting someone on purpose" among a sample of adults in a southwestern city (N = 350). Sampling from the same community and using an identical methodology, the measures were repeated in a 1992 survey (N = 396). The growing social condemnation of interpersonal violence, especially intimate violence, during the decade and the increasingly punitive response to it by the legal system lead to the hypothesis that perceived threats of shame, embarrassment, and legal sanctions for this behavior were higher in 1992 than they were in 1982. Results indicate increases for embarrassment and legal sanctions among some segments of the population and are discussed in the context of previous findings concerning shame, embarrassment, and legal sanctions as deterrents.

Adult↗
PubMed1993

Tympanometry as a screening tool in the NICU: is it effective?

This study assess the usefulness of the tympanogram as a screening tool for identifying otitis media and serous otitis media in preterm infants. Twenty-six infants from the NICU were assessed on the same day by two examiners using tympanometry and pneumatic otoscopy. The results were recorded separately and compared after all infants were tested. An audiologist independently interpreted each of the tympanogram strips. There was very little agreement between tympanometry and otoscopy results. The tympanogram was not found to be a repeatable or a reliable screening tool for assessing otitis media and serous otitis media in the NICU population. It was concluded that the NICU nurse must be aware of the signs and symptoms of otitis media and serous otitis media. If this diagnosis is raised for an infant in the NICU, careful visualization of the tympanic membrane should be carried out along with referrals to ear, nose, and throat and audiology experts.

Acoustic Impedance Tests↗