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T Powell

Publications and source records attributed to T Powell.

151 records · Page 9Linked to original sources
PubMedDate not supplied

Consultation-liaison psychiatry and clinical ethics. Representative cases.

The skills of the consultation-liaison psychiatrist are enormously valuable in the emerging field of clinical ethics consultation. Expertise in evaluating decision-making capacity is crucial, as is the larger issue of addressing the role that emotional factors play in making life or death decisions. Three cases are reviewed that illustrate the way in which the psychiatric perspective enhances the process of clinical ethics consultation.

Adult↗
PubMedDate not supplied

An isoprenaline activated sodium-dependent inward current in ventricular myocytes.

In the heart, catecholamines affect pacemaker activity by shifting the activation curve for the nonspecific inward current and increasing both the calcium current, and the delayed potassium current. We report here that in mammalian ventricle there is another mechanism that seems to involve a sodium-dependent inward current. This is elicited by agents that increase intracellular cyclic AMP concentration, such as the beta-adrenergic agonist isoprenaline, and is unaffected by agents which block the three currents listed above, but is absent when external sodium is replaced with tetramethylammonium. Most interestingly, the intracellular pathway(s) linking the beta-receptor(s) to activation of the Ca current and the Na-dependent current, which in both cases presumably involves the intracellular concentration of cAMP, differ, as isoprenaline causes a persistent augmentation of the calcium current whereas the Na-dependent current often fades. These effects of isoprenaline are antagonized by acetylcholine. In unclamped cells, the Na-dependent current depolarizes the membrane to the potential range at which repetitive firing occurs. It may therefore be involved in the generation of ventricular arrhythmias.

Acetylcholine↗
PubMedDate not supplied

MR imaging in acute multiple sclerosis: ringlike appearance in plaques suggesting the presence of paramagnetic free radicals.

MR studies in three patients with multiple sclerosis have shown clearly defined rings within plaques of demyelination, having signal characteristics consistent with the presence of paramagnetic material. It is suggested that these appearances represent the presence of free radicals in the macrophage layer forming the margin of an acute plaque.

Acute Disease↗
PubMedDate not supplied

Pressure sores and specialty beds: cost containment and ensurance of quality care.

The monitoring of specialty bed use by the certified ET nurse and the NQAC has been in full implementation since June 1989 with significant yearly cost reductions in the use of specialty care beds. The $238,000 costs from fiscal year 1987 (July 1986 to June 30, 1987) were reduced to $60,000 in fiscal year 1989 with an approximate cost savings of 75%. Additional cost savings have been achieved through the implementation of the other recommendations in this study. Although cost savings would have resulted from a stricter policy in specialty bed approval and utilization alone, such savings probably would have affected the quality of patient care. This project allowed nursing and medical staff members to work with the departments of Administration and Finance to ensure that patient care would not be significantly affected. Significant cost savings were obtained through use of the five interventions that are indicated in the introduction. Nursing was permitted to examine its own practice and implement changes in documentation, nursing standards, skin-care products, policies and procedures, and in other areas to strive for clinical excellence as monitored through its quality assurance plan. The addition of a certified ET nurse to coordinate a hospital-wide multidisciplinary approach that is consistent with and clinically relevant to current practice standards is essential to a successful program for pressure-sore prevention and management within the current reimbursement systems.

Beds↗
PubMedDate not supplied

A five-year demonstration project associated with improvement in physician health maintenance behavior.

The purpose of this demonstration project was to evaluate the effect of a sustained preventive medicine emphasis in a community hospital based family practice residency. A simplified, visually tolerable, and prominent "health maintenance guide" served as the cornerstone of the overall residency educational effort. Screening interventions and intervals were based on the major published recommendations at the initiation of the project. An audit of 100 random adult patient charts was done at baseline and yearly for five years. Physicians received both group and individual feedback regarding screening compliance on a regular basis. Overall physician compliance with screening for six basic parameters improved from 71% to 85% (P less than .0005). Physicians behavior improved significantly in recording or recommending blood pressure, physician breast exam, personal life change, tetanus/diphtheria immunization, mammography, breast self-examination, testicular self-examination, and a prudent diet. Physician use of the guide as a recording device steadily increased.

Adult↗
PubMedDate not supplied

Hemimegalencephaly and focal megalencephaly in tuberous sclerosis complex.

We describe two children with complex cortical malformations as well as the typical intracranial manifestations of tuberous sclerosis complex. One child had hemimegalencephaly and the other had extensive focal megalencephaly. These cases are discussed in terms of the current concepts of cortical malformations.

Cerebral Cortex↗