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Biomedical subjects

S Weeks

Publications and source records attributed to S Weeks.

At least 37 records · Page 2Linked to original sources
PubMed1997

Clinical implications of respect for autonomy in the psychiatric treatment of pregnant patients with depression.

Major depression, as well as depressive symptoms that do not meet the full diagnostic criteria for a diagnosis of depression, can chronically and variably affect a woman patient's decisions about the management of pregnancy, including the decision about whether to continue a pregnancy. Depression also has potential adverse consequences for the pregnant woman and her pregnancy. However, little attention has been given to the ethical challenges posed by the psychiatric management of depression during pregnancy. The psychiatrist should balance respect for the autonomy of the depressed woman with beneficence-based obligations to the pregnant woman, and also to the fetus, when the fetus is viable. The authors recommend strategies for assessing the decision-making abilities of pregnant patients with depression and for enhancing their autonomy. They suggest that nondirective counseling should generally be used with pregnant patients with depression when the fetus is previable and that directive counseling is ethically justifiable when the fetus is viable.

Abortion, Induced↗
PubMed1996

Epidural analgesia for labour in a patient with Charcot-Marie-Tooth disease.

PURPOSE: We report a case of a parturient with peroneal muscular atrophy-Charcot-Marie-Tooth disease type 1 (CMT)-who received epidural analgesia for labour. The effects of pregnancy and labour on the course of CMT are reviewed, together with the current literature on the provision of epidural and general anaesthesia in this disease. CLINICAL FEATURES: A 26-yr-old primipara with CMT was provided with epidural analgesia for labour. She experienced good pain control and suffered no untoward neurological sequelae. CONCLUSION: Epidural analgesia, after thorough discussion with the patient, may be offered to parturients with CMT.

Adult↗
PubMed1995

Epidural anaesthesia and low back pain after delivery: a prospective cohort study.

OBJECTIVE: To determine whether epidural anaesthesia during labour and delivery is a risk factor for postpartum back pain. DESIGN: Prospective cohort study with follow up at one day, seven days, and six weeks after delivery. SETTING: Teaching hospital in Montreal. SUBJECTS: 329 women who delivered a live infant(s) during the study period. Exclusion criteria were back pain before pregnancy and delivery by elective caesarean section. INTERVENTION: Epidural anaesthesia during labour and delivery. MAIN OUTCOME MEASURES AND RESULTS: The primary outcome variable was development of postpartum low back pain. Back pain was quantified with self reports (yes/no), a pain score (numeric rating scale), and degree of interference with daily activities. Of the 329 women, 164 received epidural anaesthesia during labour and 165 did not. The incidence of low back pain in epidural v non-epidural group was 53% v 43% on day one; 21% on day seven; and 14% v 7% at six weeks. The relative risk for low back pain (epidural v non-epidural) adjusted for parity, delivery, ethnicity, and weight was 1.76 (95% confidence interval 1.06 to 2.92) on day one; 1.00 (0.54 to 1.86) on day seven; and 2.22 (0.89 to 5.53) at six weeks. There were no differences between the two groups in pain scores or the frequency of interference with daily activities. Similar results were obtained in the subgroup of women with low back pain of new onset--that is, those women with no back pain during their pregnancy. CONCLUSIONS: Postpartum low back pain was common but decreased considerably over the short term. The association between epidural anaesthesia and postpartum low back pain was inconsistent over time with a significantly increased risk of low back pain (epidural v non-epidural) noted only on the first day after delivery.

Anesthesia, Epidural↗
PubMed1995

Health education: learning the techniques of persuasion.

Know your audience and tailor your message accordingly. Keep the message simple and straightforward. Consider providing written hand-outs to back up a visual presentation. Provide practical details, e.g. where and when to go for a cervical smear. Repetition is a useful technique. Consider what factors are likely to make the presenter more persuasive--e.g. gender, credibility, appearance. Encourage audience participation. The more thought and effort they put into the session, the more they will retain the message. Nurses, health visitors and midwives should be given more training in how to promote their health messages. Too many health promotion campaigns have disregarded basic techniques of persuasion and the lessons to be learned from advertising and psychology.

Female↗
PubMed1994

Psychosocial problems in primary care. Pilot study of a new taxonomy.

BACKGROUND: In this study, the Massachusetts Academy of Family Practice Research Network (MAFP ReNet) was used to test a new taxonomy of psychosocial problems presenting to family physicians and to examine physician variability in determining when a psychosocial problem plays a role in a patient's visit. METHODS: Thirty physicians completed a form listing the taxonomy of psychosocial issues for 19 standard case vignettes. These physicians then completed the same form for every patient seen in their practices over a 2-week period. RESULTS: The proposed taxonomy was well received by practicing physicians as appropriate for how they think about their patients and practices. The case vignettes demonstrated a large variability in physician identification of psychosocial problems. The 30 physicians who participated in all phases of the study completed evaluations of 2876 patient visits, identifying 43% of these as involving one or more psychosocial problems. The frequency of psychosocial problem identification among the physicians ranged from 23% to 81%, with a standard deviation of 15%. CONCLUSIONS: The proposed new taxonomy may be helpful in both future research and teaching. The high degree of variation in physician responses both to the same clinical vignettes and to patients in their practices suggests that physicians vary widely in their identification of psychosocial issues.

Adult↗
PubMed1992

Ventilatory and metabolic responses to acute hyperoxia in newborns.

Hyperoxia has previously been found to increase metabolic rate (oxygen consumption [VO2] and CO2 production [VCO2]) in newborn mammals. We asked whether the same occurs in the newborn infant. Breathing pattern was measured in 25 full-term infants, 1 to 2 days of age, from the spirometric record obtained with a pneumotachograph attached to a face mask. Concentrations of O2 and CO2 were continuously measured at the mouth; VO2 and VCO2 were computed as the product of VE and the difference between inspired and expired concentration of the respective gases, 5 min of air (FIO2 = 0.21) and 5 min of O2 (FIO2 = 1). A bias flow through the mask and pneumotachograph delivered the inspired gas and eliminated the effects of the instrumental dead space. In neither case did measurements at 1 min significantly differ from those taken at 5 min. In hyperoxia VE increased in 22 of the 25 infants, in average +18% (p less than 0.001, paired two-tailed t test). Because of a rise in tidal volume (+35%, p less than 0.001) and a decrease in breathing rate (-11%, p less than 0.005) alveolar ventilation (VA) increased by about 58% (p less than 0.001). VO2 and VCO2 increased by 25% and 17%, respectively (p less than 0.001). The rise in VO2 was too large to be explained by the greater respiratory work of the hyperventilation, whereas that of VCO2 was not large enough to fully explain the increase in VA. We conclude that in newborn humans, as in other newborn species, the normoxic metabolic rate seems to be limited by the availability of O2.(ABSTRACT TRUNCATED AT 250 WORDS)

Carbon Dioxide↗
PubMed1990

Derivatization of benz[a]anthracene metabolites for detection by laser excited Shpol'skii spectrometry.

The polar metabolites of polycyclic aromatic compounds (PACs) are of significant oncological interest. In contrast to parent PACs, isomer selective detection of polar PACs by laser excited Shpol'skii spectrometry (LESS) is severely limited by excessively broadened spectra and rapid photodegradation in n-alkane solvents. To minimize these limitations a 10-min derivatization procedure was developed to produce corresponding methoxy compounds, that exhibit the Shpol'skii effect. By use of the extraction and permethylation procedure, the selective detection of a mixture of hydroxy-benz[a]anthracene isomers spiked at the low picogram level into urine and blood matrices was achieved. A detection limit for 1-hydroxybenz[a]anthracene was 0.6 part per trillion, or 12 fg (0.05 fmol) on a 20-microL sample.

Benz(a)Anthracenes↗
PubMed1989

Difficult intubation in the parturient.

Difficult or failed tracheal intubation is an important cause of anaesthetic-related maternal morbidity and mortality. The incidence of failed intubation in parturients is estimated to be as frequent as 1 in 500; that of mortality is unknown, although some 10-13 pregnant women in England, Scotland and Wales die each year because of anaesthetic-related complications. To prevent such catastrophes, all necessary monitors and equipment should be available, including that needed to deal with a failed intubation. Assessment of the patient may lead to preoperative recognition of a difficult airway; altered positioning may be of help both in recognition and management. Furthermore, adequate assistance, correct use of cricoid pressure, and confirmation of tracheal intubation are fundamental to safe practice. Lastly, should the anaesthetist fail to intubate the patient's trachea, a management protocol is suggested.

Anesthesia, Obstetrical↗
PubMed1989

Human immunodeficiency virus: risk of exposure among health care workers at a southern urban hospital.

To assess the risk of exposure to the human immunodeficiency virus (HIV) among health care workers in a southern urban setting, random screening for antibodies to HIV was undertaken. Patients who were admitted for major trauma, for medical emergencies, or in labor were screened. Of 534 sera screened, 11 (2%) were seropositive. All but two of the seropositive patients were men. Rates were similar among black and white patients. Seven patients could be placed into an established risk group, but only one patient was known to have AIDS upon presentation to the emergency room. The mean age of seropositive individuals was 30.9 years; there were similar seroprevalence rates in each of four age groups among men. We conclude that there is a substantial risk of exposure to HIV in trauma and medical emergency centers; therefore all health care workers should practice universal barrier precautions whenever exposure to a patient's blood or body fluids is likely.

Adolescent↗
PubMed1988

Relationship between red cell sodium transport, blood pressure, and family history of hypertension.

Numerous studies have demonstrated that Na+/Li+ countertransport is increased in erythrocytes from hypertensive patients. Since Na+/Li+ countertransport is conducted through the physiologically occurring Na+/Na+ exchange, we studied the latter pathway in 20 subjects with essential hypertension and 20 normotensive subjects matched for age and sex. Ten hypertensives and six normotensives had a positive family history of hypertension. Ouabain (0.1 mM) and furosemide (0.1 mM) were used to assess the active Na+ efflux and Na+-K+-Cl- pathway. There was no significant difference between hypertensive and normotensive subjects in any of the three pathways studied. Among the 16 subjects with a positive family history of hypertension, the mean value for external Na+-dependent Na+/Na+ exchange was significantly higher than in 24 subjects with no family history of hypertension (0.0457 +/- 0.0337 versus 0.0283 +/- 0.0202; P less than 0.05). This study suggests that an inherited membrane transport defect may exist for Na+/Na+ exchange in families of hypertensive subjects.

Biological Transport↗
PubMed1987

Expression of a Tn-like epitope by carcinoma cells.

A monoclonal antibody, FBT3, was raised against Tn positive erythrocytes and, using immunohistochemistry, fresh and fixed tissues from patients with cancer were studied to detect any expression of a Tn-like epitope. Expression was found in neoplastic cells, usually both in cytoplasm and on cell membranes, from 104 of 147 cases of carcinoma and 1 of 13 cases of lymphoma, but rarely in adjacent, morphologically normal cells. Tn expression was seen in some normal glandular cells but, unlike cancer cells, it was distributed as fine granules in a supranuclear position. Detection of a Tn-like epitope is of theoretical interest and may be of direct diagnostic value.

Animals↗
PubMed1985

Mechanical aspects of chest wall distortion.

During passive inflation of the respiratory system, the rib cage (RC) expands because the pressure applied to it [approximately equal to abdominal pressure (Pab)] increases. Similar Pab-tidal volume (VT) relationships between passive and spontaneous inspirations would occur only if 1) Pab acts on RC equally in the two situations (no distortion) or 2) the extradiaphragmatic inspiratory muscles expand RC, compensating for distortion. In anesthetized adult rats and in sleeping human infants the passive relationships between VT and Pab or abdomen motion (AB) were constructed by occluding the airways during expiration. For a given Pab (or AB) in active breathing VT averaged 55% (rats) and 49% (infants) of the passive volume change. With phrenic stimulation in rats VT was only slightly less than during spontaneous breathing, indicating that, in the latter case, the respiratory system was essentially driven only by the diaphragm. In both species occasional breaths with large RC expansion occurred, and VT was then equal to or larger than the passive volume at iso-Pab. We conclude that 1) RC distortion decreases VT to approximately half of the passive value and 2) being on the relaxation curve reflects "compensated" distortion and not absence of it.

Abdomen↗
PubMed1984

Muscle pressure and flow during expiration in infants.

The postinspiratory activity of the inspiratory muscles (Pmusl) was estimated in 12 infants (2 to 4 days old) by analysis of the rise in mask pressure after airway occlusion at end inspiration. We reasoned that if at the end of inspiration Pmusl instantaneously ceased, the mask pressure would immediately increase to the relaxation pressure value corresponding to that volume. Any delay would suggest some degree of Pmusl. In 9 infants, Pmusl reached zero before the end of an average expiration (TE), although lasting for a long portion of TE (83% +/- 25 SD). We then compared the expiratory tidal flow-volume curves during resting breathing with the curves of "relaxed" expirations. In general, the tidal curve shows a linear portion that can be extrapolated to zero flow. From this extrapolation it is apparent that the end-expiratory level (FRC) is above the resting volume of the respiratory system (Vr), the FRC-Vr difference averaging 3.11 ml/kg. In 6 infants, the tidal expiratory flow-volume curve was displaced to the left of the "relaxed" curve, whereas in the remaining infants the two curves superimposed. These analyses suggest that in infants during tidal breathing (1) Pmusl can substantially contribute to the rise in FRC, and (2) the final portion of expiration is in most cases "relaxed." In some infants, however, a braking mechanism, probably of laryngeal origin, further decreases the expiratory flow and may contribute in maintaining the mean lung volume elevated.

Functional Residual Capacity↗