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Biomedical subjects

T Young

Publications and source records attributed to T Young.

At least 91 records · Page 5Linked to original sources
PubMed1997

Stress and distress in pediatric nurses: lessons from Baby K.

BACKGROUND: Nurses experience stress and suffering when they care for critically ill and dying patients. Moral distress occurs when nurses are unable to translate their moral choices into moral action. In response to this stress, nurses may experience burnout. OBJECTIVE: To investigate the attitudes and perceptions of the nurses who were ordered by the court to provide long-term care for Baby K, a female child with anencephaly. METHOD: A questionnaire was developed to provide descriptive insight into the stress and distress the nurses experienced while caring for Baby K. RESULTS: Nurses caring for Baby K experienced stress and suffering. Although they felt supported and respected as nurses in their workplace, they felt conflict with the legal system. To compensate for feelings of powerlessness, the nurses simply put on a professional face and continued to provide care. They feared making mistakes, many felt guilty and angry, and all felt that they were not included in decision making. CONCLUSIONS: (1) Suffering among caregivers occurs and must be recognized, (2) measures must be taken to reduce the stress and distress of healthcare professionals as they provide care to patients who cannot recover, and (3) in addition to these measures, society must provide guidance to healthcare professionals, especially concerning the care of patients who are permanently unconscious.

Anencephaly↗
PubMed1997

Effect of omitted confounders on the analysis of correlated binary data.

Marginal analysis using the generalized estimating equation approach is widely applied to correlated observations, as occur in studies with clusters and in longitudinal follow-up of individuals. In this article, we investigate the effect of confounding in such models. We assume that a risk factor x and a confounder z are related by a generalized linear model to the outcome y, which can be binary or ordinal. In order to investigate confounding arising from the omission of z, a joint structure for x and z must be specified. Modeling normally distributed (x,z) as sums of between- and within-individual (or cluster) components allows us to incorporate different degrees of between- and within-individual correlation. Such a structure includes, as special cases, cohort and period effects in longitudinal settings and random intercept models. The latter situation corresponds to allowing z to vary only on the between-individual (or cluster) level and to be uncorrelated with x, and leads to attenuation of the coefficient of x in marginal models with the logit and probit links. More complex situations occur when z is allowed to also vary on the within-individual (or cluster) level and when z is correlated with x. We examine the model specification and the expected bias when fitting a marginal model in the presence of the omitted confounder z. We derive general formulas and interpret the parameters and results in an ongoing cohort study. Testing for omitted covariates is also discussed.

Adult↗
PubMed1996

The gender bias in sleep apnea diagnosis. Are women missed because they have different symptoms?

BACKGROUND: Population-based studies have shown that sleep apnea is underdiagnosed in women, relative to men. One hypothesis for this gender bias is that women with sleep apnea are missed because clinical guidelines for the evaluation and diagnosis of sleep apnea, established primarily on men, are not valid for women. In this investigation, data from the Wisconsin Sleep Cohort Study, a community-based study of the natural history of sleep apnea, were used to determine whether women with sleep apnea have unique symptoms or complaints. METHODS: The sample comprised 551 men and 388 women, none of whom had ever been given a diagnosis of sleep apnea. Data on typical sleep apnea symptoms and other factors were obtained by interview and survey. Sleep apnea status was determined from the frequency of apneic and hypopneic events during sleep as recorded by in-laboratory, whole-night polysomnography. The sensitivity and relative predictive power of each symptom or factor for sleep apnea at different severity levels were calculated and compared by gender. RESULTS: Regardless of severity level, women with sleep apnea did not report symptoms that differed significantly from those of men with the same level of sleep apnea. For men and women, snoring was the most sensitive and strongest predictor of sleep apnea. CONCLUSIONS: Current clinical indications for sleep apnea evaluation are as appropriate for women as they are for men. Other reasons for the gender disparity in sleep apnea diagnosis, including the possibility that health care providers disregard typical symptoms in women, should be pursued.

Diagnosis, Differential↗
PubMed1996

Histomorphometrical analysis of the bone-implant interface: comparison of microradiography and brightfield microscopy.

Section thickness has been shown to affect the histomorphometrical measurement of bone-implant contact when analysed under brightfield microscopy. This study investigated whether microradiography of the bone-implant interface eliminated the errors associated with thick section analysis. Seven implant containing sections were utilized. Microadiographs of the thick (approximately 100 microns) sections were taken and the sections were subsequently ground to thicknesses of 50 microns and 25 microns. Photomicrographs were taken of the microradiographs and of the sections at each thickness (100, 50 and 25 microns) under brightfield microscopy. The photomicrographs were analysed for direct bone-implant contact in the cortical passage region and along the total length of the implant. The effect of section thickness on multiple fluorochrome labelling in 10 rabbit femur specimens was also examined. Centre-to-centre interlabel distance was measured for each label pair at a thickness of 100 microns and then again after the sections were ground to 50 microns and 25 microns. The thick (100 microns) sections showed a significantly greater amount of bone-implant contact than either the thin sections or the microradiographs. There was no difference in direct bone-implant contact measured by microradiography or thin sections. However, the microradiographic analysis showed a much lower variability of the bone-implant contact than the sections evaluated under brightfield microscopy. In addition, they have the added benefit of providing information on bone mineral density. Centre-to-centre interlabel distance was not significantly different for any label pair owing to section thickness. Data from this study provides evidence that the use of microradiographs for histomorphometrical analysis of the bone-implant interface is superior to brightfield analysis of thin sections owing to the lower variability of microradiographical data and the ability to obtain bone mineral density measures. Additionally, given that interlabel distance was not significantly affected by section thickness, the use of 100 microns thick sections for analysis of fluorochrome labels in cortical bone is supported.

Analysis of Variance↗
PubMed1996

Fertility, reproductive outcomes, and health of offspring, of patients treated for Hodgkin's disease: an investigation including chromosome examinations.

Reproductive outcomes and health of offspring were investigated in 340 patients with Hodgkin's disease first treated at Mount Vernon Hospital, Middlesex, England, at ages under 40 (females) or 45 (males) during 1970-91. Information on offspring was obtained from case-notes and postal questionnaires to the patients. Eleven men and 16 women who had conceived any children after treatment were then interviewed. There was no excess of stillbirths, low birthweight or cogenital malformations, and no cancers have occurred in the 49 offspring after treatment. There was a significant excess of twins, compared with national expectations, in offspring of female patients (RR = 8.52, P = 0.025). Aggregation of series from the literature also showed an excess of twins. Chromosomes from cultures of peripheral lymphocytes from 45 children born to 25 patients (11 men and 14 women) after treatment were examined for numerical abnormalities and for structural abnormalities at the 550 or greater band level of resolution. All were normal except in one child with Down's syndrome (47, XY, +21), for whom we found the origin of the trisomy was from the parent without Hodgkin's disease. The chromosome constitution was also abnormal in one miscarriage (69, XXY; originating from the parent without Hodgkin's disease) and one termination (45, X; for with the parental origin could not be determined) after treatment. The study adds to previous questionnaire data and for the first time provides data also from chromosome analysis, that offspring of patients treated in adulthood for Hodgkin's disease are not at greatly raised risk of genotoxic or other adverse outcomes as a consequence of their parent's treatment. The numbers of offspring assessed in the literature remains small, however, and surveillance of larger numbers of subjects is needed to enable reliable treatment-specific analyses.

Adult↗
PubMed1996

What are the information priorities for cancer patients involved in treatment decisions? An experienced surrogate study in Hodgkin's disease.

A total of 165 adult patients with Hodgkin's disease (HD) were questioned following treatment to examine their perceptions of actual and desired involvement and provision of information in the treatment decision-making process. Irrespective of the degree to which patients felt they had been involved in the decision-making process and of the outcome of their particular treatment, patients who felt satisfied with the adequacy of information given were significantly more likely to feel happy with their level of participation in the overall process of decision-making (P < 0.001). As part of a strategy investigating patient priorities, patients were asked to rank a series of possible acute and late treatment-related morbidities. Counter-intuitively, the majority of long-term survivors felt early short-term side-effects were more, or equally, as important as late morbidity with respect to influencing choice of therapy. Unpredictable importance was placed by patients on side-effects such as weight gain and fatigue in relation to other complications such as infertility and risk of relapse. Patients do not necessarily share doctors' priorities in decision-making or place the same emphasis on different types of morbidity. Experienced surrogates may assist us in understanding patients' perspectives and priorities.

Adolescent↗
PubMed1996

Snoring as part of a dose-response relationship between sleep-disordered breathing and blood pressure.

This report addresses the hypothesis that snoring without significant apneas and hypopneas (simple snoring) is associated with elevated blood pressure and cardiovascular disease (CVD). Data on blood pressure, previously diagnosed cardiovascular disease, and sleep-disordered breathing (SDB) status from a population-based sample of 580 adults was analyzed. Systolic and diastolic blood pressures, adjusted for age, sex, and body mass index, increased stepwise across categories of no SDB, simple snoring, mild, moderate, and more severe SDB (p < 0.05). A similar and significant trend was seen for CVD prevalence. The results provide evidence that simple snoring represents the beginning of the SDB severity spectrum and that simple snoring has a proportionately smaller but, nevertheless, significant, risk for elevated blood pressure and CVD.

Adult↗
PubMed1996

The sxa2-dependent inactivation of the P-factor mating pheromone in the fission yeast Schizosaccharomyces pombe.

Haploid cells of the fission yeast Schizosaccharomyces pombe exist in one of two mating types, referred to as M and P. Conjugation occurs between cells of opposite mating type and is controlled by the reciprocal action of diffusible pheromones. Loss of function of the sxa2 gene in M cells causes hypersensitivity to the P-factor mating pheromone and a reduction in mating efficiency. Here we demonstrate the secretion of an sxa2-dependent carboxypeptidase that inactivates P-factor by removal of the C-terminal leucine residue.

Carboxypeptidases↗
PubMed1996

Clinical spectrum of Pseudomonas putida infection.

The clinical and microbiologic characteristics of 55 cases of Pseudomonas putida infection in 53 patients in a medical center in Taiwan from April 1988 to March 1993 are reported. P. putida was cultured in the decreasing order of frequency from urine (24 isolates), sputum (12), blood (10), wound discharge (3), peritoneal fluid (3), cerebrospinal fluid (2) and umbilical swab (1). Of the adult patients, 23% (12/53) were considered to be contaminated or colonized with P. putida. Of the 41 patients with manifest disease. 17 (41%) had urinary tract infections, 10 (24%) had pneumonia, 8 (19%) had septicemia, 3 (7%) had wound infections, 2 (5%) had meningitis and 1 (2%) had peritonitis. Of these, 55% were nosocomial infections. The case fatality rate was 29% (12/41). There was no significant correlation between patient mortality and the type of disease caused by the bacterium. Results of in vitro susceptibility tests suggested that imipenem and ceftazidime were more effective than other antimicrobials. This study indicates that the clinical spectrum of diseases caused by P. putida is broader and the incidence of true infection is higher than previously expected, especially among hospitalized patients who undergo invasive procedures such as placement of intravascular devices, urinary catheterization and intubation.

Adolescent↗