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Biomedical subjects

S Young

Publications and source records attributed to S Young.

411 records · Page 23Linked to original sources

Developing your political skills. Be more effective and successful.

Organizational political skills have been generally neglected in management literature. This is unfortunate because managers who lack the requisite political skills inevitably run into difficulties on the job that reasoning and experience alone won't solve. Because politics are endemic to hospital life, laboratory managers must establish routines to deal with them. This article briefly reviews the origin of organizational political behavior and describes the political style and skills a manager needs to be effective.

Health Facility Administrators↗

Avascular necrosis of the radial head in children.

Avascular necrosis of the radial head is uncommon. A 20-year review of records at a Pediatric Trauma Center revealed eight cases of avascular necrosis of the radial head in children with an average of 10 years (range, 7-16 years). Symptoms of pain or restriction of elbow motion began at an average of 23 months after trauma in seven cases, and in one case, there was no history of trauma. Of the seven secondary to trauma, six resulted from a fall, and one from a torsional injury. The types of injuries associated with avascular necrosis of the radial head were two supracondylar fractures, a fracture of the lateral condyle, two fractures of the radius, a radial head dislocation that underwent a proximal radial osteotomy, and one with only an elbow contusion. The long-term results of radial head necrosis were poor, with three ultimately requiring radial head resection, and the remainder having considerable limitation of elbow motion. Loss of vascularity to the radial head is very analogous to avascular necrosis of the femoral head, with the late onset of incongruity, osteoarthritis, and hypertrophy of the head. It should be considered in any child with late-onset loss of elbow motion after trauma.

Adolescent↗

Pre-operative ultrasonography guiding minimal, selective surgical approach in primary hyperparathyroidism.

BACKGROUND: The traditional surgical approach for the treatment of primary hyperparathyroidism (HPT) has been routine bilateral surgical exploration. Our aim was to evaluate pre-operative ultrasonography (U/S) in altering our practice to selective unilateral neck exploration. PATIENTS AND METHODS: A retrospective study was conducted involving 53 patients who had parathyroidectomy over a 5-year period (1989-1994), 41 of whom with the diagnosis of HPT had pre-operative neck U/S. RESULTS: Thirty-eight patients had a single adenoma, one had parathyroid cancer, and two had multiple adenomas. Thirty-six of 41 (88%) patients were true positives, two (5%) false positives, two (5%) false negatives and one (2%) was true negative. Based on the surgeon's personal preference and U/S results, 21/41 (51%) of patients had bilateral and 20/41 (49%) had unilateral neck exploration. All the 41 patients had resolution of the hypercalcemia postoperatively. Eighteen of 38 (47%) patients with a single adenoma had bilateral neck exploration and only in two patients was this necessary. CONCLUSIONS: Patients undergoing parathyroid surgery for HPT should have preoperative U/S and, if a single enlarged parathyroid gland is found, unilateral U/S guided neck exploration is safe and economical. In all the other patients, bilateral exploration is the preferred approach.

Adenoma↗

A senior elective: promoting health in underserved communities.

OBJECTIVES: A fourth-year service-learning elective was developed to teach medical students about the social, economic, and culturalfactors that affect health and health-seeking behavior DESCRIPTION: The elective provides students with didactic material and educational experiences in public housing sites in the community. Students work closely with community members to implement a community health care intervention. EVALUATION: Students respond to 10 reflection questions that assess their understanding of the important community factors that affect health. CONCLUSIONS: Reflection responses demonstrate that the course has challenged assumptions, dispelled stereotypes, and enhanced awareness of the role of socialfactors in maintaining health.

Adult↗

Evaluation of patient knowledge regarding oral anticoagulants.

Warfarin sodium [Coumadin] is widely used since its introduction in 1954. The dosage varies from individual to individual and is subject to adjustment due to interactions with other medications and alcohol. It is therefore important for the patient to be educated fully regarding warfarin therapy as outside the narrow therapeutic range either failure to prevent thromboembolism or serious bleeding with potential fatal complications may occur. Patient comprehension of the risks of anticoagulation, tablet recognition skills and knowledge of complications of warfarin therapy were evaluated in 150 patients attending the anticoagulation clinic in a Dublin teaching hospital. The majority, 125 (83%) perceived that they had received education about the therapy. Concomitant aspirin was avoided by 125 (83%) patients, but 25 (17%), thought it safe in combination with warfarin; 33 (22%) believed that alcohol was safe in combination with warfarin. When asked about the colours and strengths of warfarin tablets, 125 (83%) patients identified the 1 mg tablet correctly. Only 105 (70%) identified the 3 mg tablet and 98 (65%) the 5 mg tablet correctly. In 42 (28%), patients could not describe their current therapy. Potential complications from over- and under-dosage with warfarin were unknown to 89 (59%) and 90 (60%) patients respectively. This study suggests that patient knowledge regarding anticoagulation therapy is not optimal. A significant group may be at risk from serious complications because of inadequate knowledge. We suggest improving patient knowledge may improve control, reduce complication and therefore reduce the burden on the health service.

Anticoagulants↗

Cost-effective resuscitation education.

Resuscitation education, offered by the American Heart Association, recently has expanded to include three pediatric courses. Nurse educators face internal and external constraints as they attempt to secure funding for these new programs. The Pediatric Resuscitation Course described in this article offers an innovative approach to programming and facilitates funding through the use of an integrated curriculum teaching format. This format reduces program cost without sacrificing valuable resuscitation education.

Cost-Benefit Analysis↗

Needle stick injury in pediatric hospitals.

PURPOSE: To describe the type and source of employee needle stick injuries. METHODOLOGY: A retrospective survey of documents related to 42 needle stick injuries over a 6-month period. RESULTS: Nurses experienced the greatest number of sticks. The injuries occurred most frequently at the bedside and were most often associated with IV/parenteral therapy. CONCLUSION: Needle sticks were peripheral to the problem of product design.

Accidents, Occupational↗

A model program for providing health services for migrant farmworker mothers and children.

A bilingual, multidisciplinary team of health professionals collaborated with a migrant health center in North Carolina to develop a model program to deliver primary health care services to migrant farmworker women and children. The program included case finding and outreach, coordination of maternal and child health services locally as well as interstate, and innovative health education programming. Data were collected on the health status of 359 pregnant migrant farmworker women and 560 children, ages birth to 5 years, the majority of Mexican descent, who received primary care services at the center. The mean age of the women was 23.1 years and their mean gravidity was 2.9. Dietary assessments showed that the protein intakes of most met or exceeded the U.S. Recommended Dietary Allowances, but their consumption of foods in the milk-dairy group and the fruit-vegetable group was below recommended standards. Low hematocrit was a common problem among the women (43 percent) and, to a lesser extent, among the children (26 percent). Among the infants and children, 18 percent were obese. Black American women had the highest proportion of low birth weight infants. The project emphasized coordinated services for migrant farmworker mothers and children, such as transportation services, language translation, followup, and advocacy. An outreach strategy involved case finding, home visits, and services by lay health advisors. By the third year of the project, there were increases in the average number of prenatal visits, the proportion of women entering prenatal care in their first trimester, and in the use of well-child services. The project demonstrated effective methods for delivering culturally appropriate health care services to migrant farmworkermothers and children using bilingual public health professionals.

Adult↗

The nurse preceptor: preparation and needs.

This article described a specific experience with a preceptor program. Problems inherent in the preceptor role were presented and appropriate solutions recommended. Each individual preceptor program has factors that are operational, however, many of the concepts and principles of preceptorship are transferable to any setting. By presenting our specific problems and conclusions, other programs may benefit. As professionals, we must continue to disseminate both our successes and difficulties so that professional knowledge can be enhanced.

Education, Nursing, Continuing↗

Method for determination of organohalogen pesticide residues in vegetable oil refinery by-products.

A method using gel permeation and Florisil column chromatographic cleanup techniques is described for determination of residues of nonpolar organohalogen pesticides and pesticide alteration products in vegetable oils and their refinery by-products. Supplemental Florisil separation and alkali cleanup techniques are used to facilitate determinations. Residues are determined with a 63Ni electron capture gas chromatographic detection system used in conjunction with 3 different gas chromatographic columns. Residue identities are confirmed by gas chromatography-mass spectrometry. Recoveries of 7 organohalogen pesticides, ranging from 90 to 103%, were determined by the supplemental Florisil separation technique to augment previously reported recovery data determined for initial GPC and Florisil cleanup steps. Soybean, peanut, and cottonseed deodorizer distillates and crude and refined oil, as well as additional refinery by-products, were analyzed. Nine to 13 organohalogen residues ranging from 0.5 to 6.3 ppm were determined in the 2 soybean deodorizer distillate samples used to develop and test the method. Identities of residues present at greater than or equal to 0.3 ppm were confirmed by gas chromatography-mass spectrometry. An intralaboratory trial of the method provided additional recovery and residue determination data as follows: Recoveries ranging from 102 to 116% were obtained for 4 pesticides added to peanut oil deodorizer distillate. Residues determined in 1 soybean deodorizer distillate sample supported previously obtained data for this sample.

Chromatography, Gas↗

Effects of hospital downsizing on surviving staff.

In 1993, 27% of 1,147 surveyed hospitals planned to decrease staff size in the next year. This study surveyed 48 vice presidents of nursing in North Carolina hospitals with an average inpatient census over 100 using a 13-item questionnaire in an effort to discover strategies that were helpful in effective downsizing endeavors. Of the 31 (48%) returned questionnaires, 11 (35%) of the VPs reported downsizing in the past 3 years, most of which required the closing of one or more units. The respondents ranked attrition as the most common strategy, followed by relocation, early retirement, a change in skill mix, and layoffs. The most important components in successful downsizing or reorganization efforts were: two-way communication and sufficient planning, as well as seeking and using input from a broad group of staff (using both individual meetings and group forums/discussions).

Adaptation, Psychological↗