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Biomedical subjects

T Clark

Publications and source records attributed to T Clark.

At least 55 records · Page 3Linked to original sources
PubMed1996

Estimation of fetal lung volume using enhanced 3-dimensional ultrasound: a new method and first result.

OBJECTIVE: To measure fetal lung volume using a computer based, enhanced, 3-dimensional ultrasound imaging system. DESIGN: An observational study. SETTING: The Fetal Medicine Unit at Guys Hospital, London. PARTICIPANTS: Twenty healthy women with a singleton pregnancy between 24 and 36 weeks of gestation were scanned on one occasion during pregnancy using an ultrasound based 3-dimensional imaging system. All delivered at term with weights above the 10th centile for gestation. RESULTS: Total lung volume increased exponentially with gestational age. Right lung volume measured consistently greater than left lung volume. CONCLUSIONS: The use of this new enhanced 3-dimensional imaging system allows for estimations of fetal lung volume. Preliminary data confirm that fetal lung volume, measured by a computerised 3-dimensional ultrasound imaging system increased exponentially with gestational age. The use of this system has obvious application in the further study of lung growth in utero and possible clinical application in disease states where fetal lung growth may be impaired.

Female↗
PubMed1994

The effectiveness of an intervener model of services for young deaf-blind children.

Project Validation of the Intervener Program (VIP) studied and documented the effectiveness of the Intervener Service Model which provides the services of a paraprofessional (called an intervener) to families of young children who are deaf-blind. The intervener provides auditory, visual, and tactile stimulation for the child and helps the child develop interactive behaviors instead of isolated, defensive, or self-stimulatory behaviors. The intervener also enables the parents to obtain much needed respite. Project VIP obtained abundant quantitative and qualitative data on the effectiveness of the Intervener Service Model. The data strongly support the need for Intervener Services for young children who are deaf-blind and their families.

Blindness↗
PubMed1994

Right hemispace presentation and left cueing on Raven's Coloured Progressive Matrices among right brain-damaged neglect patients.

Despite the substantial experimental literature that has accrued on factors associated with a reduction in neglect, few empirical studies have attempted to extrapolate these findings to clinical assessment and evaluate the efficacy of neglect-reducing strategies on patient performance. The current study developed a modified version of the Raven's Coloured Progressive Matrices (RCPM) by aligning the response alternatives in a column, in the right hemispace. Three groups of patients (right brain-damaged (RBD) with neglect, RBD without neglect, and orthopaedic controls) were administered abbreviated versions of the revised format, and performance was compared to the standard presentation format. The efficacy of left cues with the revised format was also investigated. Presence of neglect was assessed via the Schenkenberg Line Bisection Task and the Bells Test. Results showed a significant performance decrement among RBD neglect patients under all conditions. However, contrary to predictions, RBD neglect patients did not reveal significantly better performance on the revised version as compared to the standard presentation format. No significant effects associated with left side cueing were observed. The finding that no significant performance changes emerged as a function of stimulus modification and verbal prompts suggests that, although these manipulations may be employed by clinicians to maximize patient performance, empirical support for the efficacy of these procedures is lacking.

Adult↗
PubMed1994

Automated order-entry mechanisms to influence prescribing.

On-line prescribing is available in many hospitals in the United States and has distinct advantages. On-line drug prescribing can be influenced by the use of automated prompts that guide and direct the prescriber to the preferred agent, dosage, or regimen. The authors have adapted screen prompts to facilitate appropriate prescribing as defined by pharmacy and therapeutic (P&T) committee decisions, restricted drug or target drug initiatives, drug-usage evaluation (DUE) actions, departmental guidelines and order-sets, and other institutional directives. Objective evidence for the effectiveness of on-line prompts is provided for H2-antagonists and antibiotics. As computer technology advances even further and is increasingly utilized in the health care setting, on-line interventions to facilitate appropriate prescribing may become increasingly useful.

Anti-Bacterial Agents↗
PubMed1994

The RN and LPN skill mix.

Until a few years ago, patient care in most acute care areas at our tertiary care hospital in Alberta was delivered almost exclusively by registered nurses (RNs). Many believed their workload included tasks that did not require an RN's knowledge and skill levels. Around the same time, the hospital was faced with budget constraints. The staffing mix changed in 1991 with the introduction of another level of caregiver in the active treatment areas--licensed practical nurses (LPNs). The new mix caused problems: many RNs were unaccustomed to supervising and delegating to other workers and the primary nursing method for delivering patient care no longer worked.

Clinical Nursing Research↗
PubMed1993

The effect of immediate intraperitoneal carboplatinum on wound healing.

The effect of introducing intraperitoneal carboplatinum on wound healing immediately after wound closure was studied using a rat model. All animals were opened through a midline incision. A bowel anastomosis was then performed in a single-or two-layer fashion using 6-O suture. Immediately after closing the abdominal wall, each animal was percutaneously injected with either normal saline for controls (n = 11), or carboplatinum, 3 (n = 8), 9, (n = 19, or 12 mg/kg (n = 4). Abdominal and skin incisions were closed separately using 4-O silk suture. Animals were sacrificed 7 days postoperatively. Adhesions were blindly assessed on the following scale: 0 (no adhesions), 1 (filmy adhesions), 2 (firm adhesions), and 3 (dense adhesions). Anastomoses were assessed for leakage. Three centimeters of the incision were harvested to evaluate wound breaking strength. Analysis of abdominal wound breaking strengths showed control = 1320 g +/- 220, 3 mg = 1055 g +/- 155, 9 mg = 891 g +/- 127, and 12 mg = 594 g +/- 165 (P < 0.025). Evaluation for dense adhesions resulted in control = 27%, 3 mg/kg = 50%, 9 mg = 63%, and 12 mg = 100% (P < 0.0001). Immediate instillation of intraperitoneal carboplatinum had a significant effect on wound healing with a decrease in abdominal tensile strength directly related to the dose instilled. It also had a significant effect on adhesion formation with a higher dose leading to a higher incidence of adhesion formation. Based on animal model data, it appears that the immediate instillation of intraperitoneal carboplatinum at the time of laparotomy incision closure could lead to significant problems with wound strength and adhesion formation.

Animals↗
PubMed1993

The tidal volume response to incremental exercise in COPD.

Patients with severe COPD often exhibit a ventilatory limit to exercise. This is associated with a shallow breathing pattern when compared with normal control subjects. It is unclear, however, what factors affect differences in breathing patterns within this patient population. To further investigate the tidal volume (VT) response to exercise in severe COPD, nine patients were recruited to undergo a maximal incremental exercise test. Pulmonary function tests, collection of expired gases, and continuous pulse oximetry were performed. As a group, the results were as follows (mean +/- SD): The FEV1 was 31 +/- 7 percent of predicted, the FRC was 143 +/- 18 percent of predicted, and the DCO was 47 +/- 15 percent of predicted. Exercise testing showed an oxygen consumption at peak exercise of only 44 +/- 9 percent predicted, a dyspnea index of 101 +/- 19 percent predicted, a heart rate at peak exercise of 75 +/- 12 percent predicted, a tidal volume at peak exercise (PKVT) of 1.23 +/- .35, a respiratory rate at peak exercise (PKfb) of 26 +/- 6, and an oxygen saturation at peak exercise (PKO2sat) of 96 +/- 4 percent. An anaerobic threshold (AT) occurred in seven of the nine patients at a mean of 31 +/- 8 percent predicted maximal oxygen consumption. Regression analysis showed the PKVT to be inversely correlated with the FEV1 (r = -0.76; p = 0.01) and the PKfb (r = -0.85; p = 0.003), while positively correlating with the FRC (r = +0.80; p = 0.01) and the PKO2sat (r = +0.69; p = 0.04). Additionally, there was a trend for the PKVT to be inversely related with the AT (r = -0.72; p = 0.06). In COPD, the more severe the obstruction and hyperinflation, the larger the VT response to exercise. This may serve to avoid a deleterious increase in autoPEEP by promoting a lengthening of the expiratory time. Furthermore, given the association of an earlier AT and a higher PKO2sat with a larger PKVT, this would suggest that such a response may minimize the effects of dead space and/or autoPEEP on O2 delivery (early AT).

Anaerobic Threshold↗
PubMed1993

Hospital mainframe computer documentation of pharmacist interventions.

The hospital mainframe computer pharmacist intervention documentation system described has successfully facilitated the recording, communication, analysis, and reporting of interventions at our hospital. It has proven to be time efficient, accessible, and user-friendly from the standpoint of both the pharmacist and administrator. The advantages of this system greatly outweigh manual documentation and justify the initial time investment in its design and development. In the future, it is hoped that the system can have even broader impact. Intervention/recommendations documented can be made accessible to medical and nursing staff, and as such further increase interdepartmental communication. As pharmacists embrace the pharmaceutical care mandate, documenting interventions in patient care will continue to grow in importance. Complete documentation is essential if pharmacists are to assume responsibility for patient outcomes. With time being an ever-increasing premium, and with economic and human resources dwindling, an efficient and effective means of recording and tracking pharmacist interventions will become imperative for survival in the fiscally challenged health care arena. Documentation of pharmacist intervention using a hospital mainframe computer at UIH has proven both efficient and effective.

Chicago↗
PubMed1991

An investigation of the relationship between self-report of memory functioning and memory test performance.

Memory complaints are some of the most common cognitive problems presented to clinical psychologists and neuropsychologists. However, the probable validity of memory complaints presented to a psychologist rarely has been validated by objective memory tests. Using the Memory Functioning Questionnaire (MFQ; Gilewski et al., 1983), 62 relatively young adults reported the extent to which they were experiencing various types of memory problems. These data were compared with findings of memory and non-memory tests on an expanded Halstead-Reitan test battery and with the MMPI/MMPI-2. Results showed that with the exception of persons with more than one MMPI/MMPI-2 evaluation, memory complaints were not related more to memory than to non-memory tests.

Adolescent↗
PubMed1991

Conceptual data model for a central patient database.

This paper presents methods used to develop a conceptual model for a patient database forming the centerpiece of a clinical information system under development. Various modeling techniques are discussed using a simplified fragment of the model. A method for mapping the model onto a relational design optimized for single patient retrievals is described. The results section discusses a number of issues pertaining to the flexibility and usability of this architecture.

Databases, Factual↗
PubMed1991

Hospital administrators' perceptions of pharmacy directors.

The results of a national survey of hospital administrators' perceptions of pharmacy directors are reported. A questionnaire was mailed to a random sample of 1000 hospital administrators nationwide. The questionnaire asked each administrator to rate the managerial skills of pharmacy directors in general and the pharmacy director at his or her institution on a 5-point scale. The value the administrator placed on clinical pharmacy services was investigated, as was the administrator's knowledge of the education of the pharmacy director and the reporting structure between administrator and pharmacy director. The net response rate was 47.8% (478 usable replies). The hospital administrators believed that pharmacy directors in general need to improve their relationship with the nursing staff, their basic managerial skills, and their communication skills. They believed that the pharmacy director at their own institution excelled at keeping up with progressive pharmacy practice, inventory management, and interacting with the pharmacy and therapeutics committee. The administrators indicated that it is very important for the pharmacy department to be involved in therapeutic drug monitoring and medication counseling and to be progressive in their offerings of services. Hospital administrators had a positive perception of the abilities of pharmacy directors but believed that there is still room for improvement.

Attitude of Health Personnel↗
PubMed1990

The development of a points system to compare the potential running costs of different development options for new hospitals.

The points system provides a simple method of assessing the design aspects of health care facilities which have a significant influence on their eventual operating costs. It is intended to assist planning teams working in the early stages of designing a health care facility. The system offers a systematic form of analysis which should be used in the preparation of development proposals as an aide-memoir, and as a method of comparing and evaluating alternative design solutions. It comprises seventeen worksheets which should be used by planning teams as a checklist of Design for Reduced Operating Costs factors. The system was developed by using the 'delphi' methodology and has been tested in a series of repeatability tests and field trials; and it is now being used for developments within the NHS.

Costs and Cost Analysis↗
PubMed1990

[Distribution of linear accelerators in Great Britain. Use of fast electrons and their main applications].

The features of the electron beam that make it a unique therapeutic tool, are related to physical characteristic rather than to any special biological effectiveness. The advantages of the dose distribution pattern are greatest at low energies (under 20 MeV), suggesting the use of electrons for irradiation of superficial tumors with the sparing of underlying tissues. Modern clinical electron practice demands electron treatment beams offering a high degree of purity, uniformity and the steepest possible fall-off of dose beyond the treatment volume. There are approximately 135 Linacs installed in UK, and approximately half of them have electron capacity with range of energy between 4 and 15/20 MeV. Compared to photon beams, 10% of treatment load is for electrons with a maximum of 15% in very specialised centres.

Electrons↗
PubMed1989

Pointing the way.

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Capital Expenditures↗