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PubMed1985

Nutritional consequences of drugs used in pediatrics.

Pediatric drugs may have significant nutritional consequences via their effects on appetite, nutrient absorption, nutrient metabolism, and nutrient excretion. Examples of common drugs and effects on nutrition include the inhibition of vitamin C storage by aspirin; impairment of folic acid utilization by phenobarbital; phenylalanine accumulation by trimethoprim; and lipolysis caused by caffeine. Nutritional consequences of drugs are of greater clinical significance in children who are malnourished and in those on drugs for prolonged periods. It is important that physicians consider possible deleterious consequences of drugs in making therapeutic choices.

Appetite↗
PubMedDate not supplied

Assessing the metabolic and clinical consequences of early enteral feeding in the malnourished patient.

BACKGROUND: It is often thought that enteral feeding should be initiated slowly in those who are severely malnourished. This descriptive study examined the effect of an enteral feeding protocol on the typical metabolic consequences seen in refeeding syndrome. METHODS: A retrospective chart review was conducted on 51 patients who had been placed on hospital-wide enteral feeding and electrolyte replacement protocols over a 9-month period to determine whether there were any negative clinical consequences to early feeding. RESULTS: Goal feeding rate was achieved within 17.6 +/- 8.7 hours. Forty patients (80%) developed depletions in phosphate, magnesium, or potassium after initiation of enteral feeding, including 93% of those deemed "at risk" and 74% of those "not at risk." All patients received electrolyte replacement according to protocols, and no patients showed any negative clinical effect. CONCLUSIONS: This study showed that malnourished patients at risk for refeeding syndrome can be fed early without observed negative clinical consequences. An electrolyte replacement protocol may be an effective means of minimizing the electrolyte imbalances associated with early feeding. It also demonstrated the significance of applying such protocols to all patients requiring enteral support, as current methods of assessing "risk"for refeeding syndrome may be inadequate.

Adult↗
PubMedDate not supplied

A review of physician turnover: rates, causes, and consequences.

To assess current knowledge about physician turnover, this article reviews the available literature regarding the rates, causes, and consequences of physicians' leaving a practice. Reported rates of turnover vary widely, both because of differences in reporting methods and by type of healthcare organization and provider. A common contributor to turnover is a mismatch between physicians' expectations and organizational culture or rules, although greater understanding of ways to assess and to predict such mismatch is needed. The costs and consequences of physician turnover are substantial and may include: (a) financial consequences, (b) effects on patient satisfaction, and (c) effects on the organization or practice as a whole, related to the experience of other healthcare providers, and effects on institutional public relations. Our review suggests that greater attention to physician turnover is needed to clarify its frequency and predictors, and strategies to lessen its occurrence.

Attitude of Health Personnel↗
PubMed2004

An integrative review of separation in the context of victimization: consequences and implications for women.

Given the number of divorces that occur each year as well as the high rates of intimate partner violence, it is critical that divorce/separation and victimization be considered in research and in clinical practice with women. However, the separation/divorce research and victimization research has often been conducted independently, with limited attention to integration. The integration of these two domains is critically important in facilitating the understanding of these issues for women. This article has 5 main purposes: (a) to review the research on the general consequences of separation; (b) to review the research on the consequences of separation when children are involved; (c) to review the research on the consequences of victimization; (d) to integrate the separation and victimization research to examine separation in the context of victimization; and (e) to discuss the implications of separation in the context of victimization for practice and research.

Battered Women↗
PubMed2005

Intimate partner violence, employment,and the workplace: consequences and future directions.

The purpose of this article is to examine the literature on violence against women and employment. After a brief discussion of the definition and consequences of intimate partner violence, the article reviews the research and related literatures to describe the (a) types of job interference tactics used by abusers, (b) employee-level consequences of partner violence, (c) victimized employee responses to intimate partner violence, (d) organizational-level consequences of partner violence, and (e) employer responses to intimate partner violence. Future research directions and workplace implications are discussed.

Battered Women↗
PubMed2001

Functional consequences of naturally occurring mutations in human uroporphyrinogen decarboxylase.

Functional consequences of 12 mutations-10 missense, 1 splicing defect, and 1 frameshift mutation-were characterized in the uroporphyrinogen decarboxylase (URO-D) gene found in Utah pedigrees with familial porphyria cutanea tarda (F-PCT). All but one mutation altered a restriction site in the URO-D gene, permitting identification of affected relatives using a combination of polymerase chain reaction and restriction enzyme digestion. In a bacterial expression system, 3 of the missense mutants were found in inclusion bodies, but 7 were expressed as soluble proteins. Enzymatic activity of soluble, recombinant mutant URO-D genes ranged from 29% to 94% of normal. URO-D mRNA levels in Epstein-Barr-virus transformed cells derived from patients were normal (with the exception of the frameshift mutation) even though protein levels were lower than normal, suggesting that missense mutations generally cause unstable URO-Ds in vivo. The crystal structures of 3 mutant URO-Ds were solved, and the structural consequences of the mutations were defined. All missense mutations reported here and by others were mapped to the crystal structure of URO-D, and structural effects were predicted. These studies define structural and functional consequences of URO-D mutations occurring in patients with F-PCT.

Cell Line, Transformed↗
PubMed2003

Health consequences associated with frequent wheezing in adolescents without asthma diagnosis.

Using questions from the International Study of Asthma and Allergies in Childhood, this study evaluated the association between undiagnosed frequent wheezing and health consequences in adolescents. The North Carolina School Asthma Survey provided self-reported questionnaire data on respiratory health from 122,829 children aged 12-14 yrs. The frequency of health consequences were compared among undiagnosed frequent wheezers, diagnosed asthmatics, and children with no wheezing symptoms or diagnosed asthma. The odds of wheezing-related sleep disturbances, limited activities, and missed school were higher among undiagnosed frequent wheezers, relative to diagnosed asthmatics. The frequency of emergency room visits and hospitalisations did not differ substantially between the undiagnosed wheezing and diagnosed asthma groups, though the undiagnosed group was less likely to have visited a physician for wheezing in the past year. Children with frequent wheezing symptoms but no asthma diagnosis experience substantial illness-related morbidity similar to that of diagnosed asthmatics. Undiagnosed frequent wheezers require more recognition from primary care physicians and need active disease management to reduce health consequences.

Absenteeism↗
PubMed1998

Cardiorespiratory consequences of sleep apnoea syndrome in patients with massive obesity.

Assessment of cardiorespiratory consequences of sleep apnoea syndrome (SAS) is difficult owing to confounding factors, especially obesity, that are strongly associated with SAS. This study was designed to assess the cardiorespiratory consequences of SAS by comparing the results of a comprehensive cardiorespiratory evaluation in apnoeic and nonapnoeic patients with massive obesity. In a retrospective chart-review study, we studied 60 patients with massive obesity defined by a body mass index (BMI) >40 kg.m(-2), presenting no chronic respiratory disease, who underwent an extensive assessment of cardiorespiratory consequences of obesity, including overnight polysomnography, lung function tests, arterial blood gas analysis, evaluation of vascular risk factors, myocardial scintigraphy with dipyridamole stress-test, isotopic ventriculography, Doppler echocardiography and Holter electrocardiogram recording. SAS defined by an apnoea + hypopnoea index (AHI) > or = 10 was diagnosed in 42% of patients (25 out of 60). Mean+/-SD AHI of SAS-positive (SAS+) patients was 38+/-24. Age, BMI, ventilatory function parameters, prevalence of smoking history and diabetes mellitus did not differ significantly in SAS+ versus SAS-negative (SAS-) groups. The following complications were observed more frequently in SAS+ than in SAS- patients: daytime hypoxaemia (35 vs 9%, p<0.02), pulmonary arterial hypertension (36 vs 7%, p<0.05) and increased interventricular septal thickness (50 vs 15%, p<0.03). No association was found between SAS on the one hand and systemic arterial hypertension, coronary artery disease, left ventricular dysfunction and nocturnal cardiac arrhythmias on the other. Nocturnal apnoeas in massive obesity may thus be associated with moderate daytime hypoxaemia, mild pulmonary arterial hypertension and moderate left ventricular hypertrophy, but not with severe cardiorespiratory complications.

Adult↗
PubMed2006

Falls and consequent injuries in hospitalized patients: effects of an interdisciplinary falls prevention program.

BACKGROUND: Patient falls in hospitals are common and may lead to negative outcomes such as injuries, prolonged hospitalization and legal liability. Consequently, various hospital falls prevention programs have been implemented in the last decades. However, most of the programs had no sustained effects on falls reduction over extended periods of time. METHODS: This study used a serial survey design to examine in-patient fall rates and consequent injuries before and after the implementation of an interdisciplinary falls prevention program (IFP) in a 300-bed urban public hospital. The population under study included adult patients, hospitalized in the departments of internal medicine, geriatrics, and surgery. Administrative patient data and fall incident report data from 1999 to 2003 were examined and summarized using frequencies, proportions, means and standard deviations and were analyzed accordingly. RESULTS: A total of 34,972 hospitalized patients (mean age: 67.3, SD +/- 19.3 years; female 53.6%, mean length of stay: 11.9 +/- 13.2 days, mean nursing care time per day: 3.5 +/- 1.4 hours) were observed during the study period. Overall, a total of 3,842 falls affected 2,512 (7.2%) of the hospitalized patients. From these falls, 2,552 (66.4%) were without injuries, while 1,142 (29.7%) falls resulted in minor injuries, and 148 (3.9%) falls resulted in major injuries. The overall fall rate in the hospitals' patient population was 8.9 falls per 1,000 patient days. The fall rates fluctuated slightly from 9.1 falls in 1999 to 8.6 falls in 2003. After the implementation of the IFP, in 2001 a slight decrease to 7.8 falls per 1,000 patient days was observed (p = 0.086). The annual proportion of minor and major injuries did not decrease after the implementation of the IFP. From 1999 to 2003, patient characteristics changed in terms of slight increases (female gender, age, consumed nursing care time) or decreases (length of hospital stay), as well as the prevalence of fall risk factors increased up to 46.8% in those patients who fell. CONCLUSION: Following the implementation of an interdisciplinary falls prevention program, neither the frequencies of falls nor consequent injuries decreased substantially. Future studies need to incorporate strategies to maximize and evaluate ongoing adherence to interventions in hospital falls prevention programs.

Accidental Falls↗
PubMed2001

The neurobiology and consequences of epilepsy in the developing brain.

Epilepsy is a disorder in which the balance between cerebral excitability and inhibition is tipped toward uncontrolled excitability. There is now clear evidence that there are distinct differences between the immature and mature brain in the pathophysiology and consequences of seizures. Both the enhanced excitability of the immature brain compared with the mature brain and the unique pathologic consequences of seizures are related to the sequential development and expression of essential signaling pathways. Although the immature brain is less vulnerable than the mature brain to seizure-induced cell death, seizures in the developing brain can result in irreversible alterations in neuronal connectivity. Developing novel strategies to treat and avert the consequences of seizures in children will require further understanding of the unique mechanisms of seizure initiation and propagation in the immature brain.

Brain↗
PubMed2005

Racial differences in socially desirable responding in selection contexts: magnitude and consequences.

Two studies were conducted to examine the magnitude and consequences of racial differences on social desirability (SD) scales. Study 1 included 1,063 job applicants, and Study 2 included 3 sets of incumbents (total N = 534). In both studies, participants were administered several personality measures and an SD scale. Across all samples, Whites scored lower on the SD scale than Blacks (average d = .37), Hispanics (average d = .47), and Asians (average d = 1.04), but these differences were not observed on the personality scales. The consequence of differences in socially desirable responding (SDR) is that fewer minority group members would be selected if SD scales were used to derive cut scores to eliminate individuals from the applicant pool or if the scales were used to correct personality test scores for SDR. However, applying the SD correction did not affect the validity of the personality test for any of the racial groups. Overall, our findings suggest that researchers and practitioners should consider the use of SD scales very carefully, as their use may have unintended consequences. These studies also demonstrate a need to closely examine the construct validity of SD measures across diverse groups.

Adult↗
PubMed1996

Mutations to forskolin resistance result in loss of adrenocorticotropin receptors and consequent reductions in levels of G protein alpha-subunits.

A family of mutants isolated from the Y1 mouse adrenal cell line on the basis of their resistance to the growth inhibitory effects of forskolin have an underlying mutation that affects the activity of adenylyl cyclase. As part of the mutant phenotype, adenylyl cyclase is partially resistant to activation by forskolin, completely insensitive to ACTH, and fully responsive to NaF; the levels of Gs alpha and G1 alpha in plasma membrane fractions are decreased; and the activity of G beta/gamma is impaired. In the present study, we examine the basis for the complex phenotype associated with forskolin resistance to better understand the factors that contribute to the regulation of adenylyl cyclase activity. We demonstrate that the resistance of these mutants to ACTH results from the failure to express ACTH receptor transcripts. Transfection of these mutants with a gene encoding the mouse beta 2-adrenergic receptor led to the recovery of transformants with normal receptor-G protein coupling and with increased levels of Gs alpha and G1 alpha that approached those in parental Y1 cells. These beta 2-adrenergic receptor transformants, nonetheless, remained resistant to forskolin and ACTH. Two spontaneous Y1 mutants, Y6 and OS3, previously characterized as ACTH-resistant clones that failed to accumulate ACTH receptor transcripts, were shown to be forskolin resistant and to contain less Gs alpha in membrane fractions, indicating that forskolin resistance, failure to express the ACTH receptor, and the consequent reduction in Gs alpha are closely linked. Expression of the human ACTH receptor in Y6 and OS3 cells restored ACTH-responsive adenylyl cyclase activity and increased the level of Gs alpha, but did not otherwise reverse the forskolin-resistant phenotype. Together, these results demonstrate that mutations to forskolin resistance have downstream consequences that result in the loss of ACTH receptor expression and the consequent reduction in levels of membrane-associated G alpha subunits. The results further suggest that G protein-coupled receptors may have a stabilizing influence on G alpha subunits associated with the cell membrane. According to current models, forskolin activates adenylyl cyclase by forming a ternary complex with adenylyl cyclase and Gs alpha. Our results suggest that this model may be incomplete and that an additional component, acting directly or indirectly, is required for optimal activation of adenylyl cyclase by forskolin.

Adenylyl Cyclases↗
PubMed2000

Functional consequences of chloride channel gene (CLCN1) mutations causing myotonia congenita.

OBJECTIVE: To determine the functional consequences of missense mutations within the skeletal muscle chloride channel gene CLCN1 that cause myotonia congenita. BACKGROUND: Myotonia congenita is a genetic muscle disease associated with abnormalities in the skeletal muscle voltage-gated chloride (ClC-1) channel. In order to understand the molecular basis of this inherited disease, it is important to determine the physiologic consequences of mutations found in patients affected by it. METHODS: The authors used a mammalian cell (human embryonic kidney 293) expression system and the whole-cell voltage-clamp technique to functionally express and physiologically characterize five CLCN1 mutations. RESULTS: The I329T mutation shifted the voltage dependence of open probability of ClC-1 channels to the right by 192 mV, and the R338Q mutation shifted it to the right by 38 mV. In addition, the I329T ClC-1 channels deactivated to a lesser extent than normal at negative potentials. The V165G, F167L, and F413C ClC-1 channels also shifted the voltage dependence of open probability, but only by +14 to +20 mV. CONCLUSIONS: The functional consequences of these mutations form the physiologic argument that these are disease-causing mutations and could lead to myotonia congenita by impairing the ability of the skeletal muscle voltage-gated chloride channels to maintain normal muscle excitability. Understanding of genetic and physiologic defects may ultimately lead to better diagnosis and treatment of patients with myotonia congenita.

Chloride Channels↗
PubMed2003

Healthcare restructuring with a view to equity and efficiency: reflections on unintended consequences.

This paper is developed from a research study that examined the hospitalization and helpseeking experiences of diverse ethnocultural populations in the era of healthcare restraint. Interview data were gathered from 60 patients while hospitalized and after their discharge home. Fifty-six healthcare professionals, the majority of whom were nurses caring for these patients while they were in hospital, were also interviewed. The data gathered in this study provides evidence to illustrate how restructuring associated with fiscal restraint designed to enhance efficiencies while ensuring the provision of medically necessary services, has had unintended consequences for some groups of patients and for nurses. These consequences have created a context for inequities in care delivery for those most vulnerable. In this paper we trace the ways in which the changed context of care delivery has exerted its effects on both nurses and patients and illustrate how each has sought to bridge gaps created when organizational supports are lacking. Our study data offer insight into the complexities of the practice setting and difficulties that arise when resources cannot be mobilized to match patients' needs. Our analysis examines how tensions between ideologies of efficiency and accessibility are navigated at the front lines, and draws attention to unintended consequences of the current policy context.

Adult↗
PubMed2001

Staff members' prediction of consequences for their work in residential settings.

Staff members supporting people with mental retardation in residential care were given scenarios describing tasks they might carry out and asked what would happen if they did, or failed to do, them (i.e., who would notice, what would their reaction be). Only a minority reported strong, certain consequences for anything they did from residents, families, or external professionals. Although a majority reported consequences from managers or coworkers, a large minority did not. The tasks for which most staff members reported consequences were administration, followed by enabling residents. Results suggest that staff members who give priority to administration may be responding to the contingencies established by their managers and that a shift in priorities may be required to improve staff members' interactions with clients.

Adult↗
PubMed2001

Models for combining random and systematic errors. assumptions and consequences for different models.

A series of models for handling and combining systematic and random variations/errors are investigated in order to characterize the different models according to their purpose, their application, and discuss their flaws with regard to their assumptions. The following models are considered 1. linear model, where the random and systematic elements are combined according to a linear concept (TE = absolute value(bias) + z x sigma), where TE is total error, bias is the systematic error component, sigma is the random error component (standard deviation or coefficient of variation) and z is the probability factor; 2. squared model with two sub-models of which one is the classical statistical variance model and the other is the GUM (Guide to Uncertainty in Measurements) model for estimating uncertainty of a measurement; 3. combined model developed for the estimation of analytical quality specifications according to the clinical consequences (clinical outcome) of errors. The consequences of these models are investigated by calculation of the functions of transformation of bias into imprecision according to the assumptions and model calculations. As expected, the functions turn out to be rather different with considerable consequences for these types of transformations. It is concluded that there are at least three models for combining systematic and random variation/errors, each created for its own specific purpose, with its own assumptions and resulting in considerably different results. These models should be used according to their purposes.

Algorithms↗
PubMed2004

Positive and negative consequences of HIV disclosure among seropositive injection drug users.

This study examines HIV status disclosure in an ethnically diverse sample of HIV-seropositive injection drug users (IDUs) from New York City and San Francisco. Qualitative interviews were conducted with 158 participants. Analyses revealed a number of negative and positive consequences of disclosing serostatus to sexual partners. Negative consequences included stigma, rejection by sexual partners and others, loss of intimacy, and threats to personal well-being. Positive rewards resulting from disclosure included increased social support and intimacy with partners, reaffirmation of one's sense of self, and the opportunity to share personal experiences and feelings with sexual partners. The role of responsibility in impacting disclosure and nondisclosure revealed varied patterns in terms of how this construct impacts disclosure and resulting behaviors with sexual partners. Some participants used particular strategies, such as getting involved in seroconcordant relationships or minimizing intimacy in relationships, in order to combat potential negative outcomes of disclosure. For others, positive rewards were viewed as important enough to risk negative consequences. Interventions for HIV-positive IDUs are discussed.

Adult↗
PubMed2006

Why does the brain predict sensory consequences of oculomotor commands? Optimal integration of the predicted and the actual sensory feedback.

When the brain initiates a saccade, it uses a copy of the oculomotor commands to predict the visual consequences: for example, if one fixates a reach target, a peripheral saccade will produce an internal estimate of the new retinal location of the target, a process called remapping. In natural settings, the target likely remains visible after the saccade. So why should the brain predict the sensory consequence of the saccade when after its completion, the image of the target remains visible? We hypothesized that in the post-saccadic period, the brain integrates target position information from two sources: one based on remapping and another based on the peripheral view of the target. The integration of information from these two sources could produce a less variable target estimate than is possible from either source alone. Here, we show that reaching toward targets that were initially foveated and remapped had significantly less variance than reaches relying on peripheral target information. Furthermore, in a more natural setting where both sources of information were available simultaneously, variance of the reaches was further reduced as predicted by integration. This integration occurred in a statistically optimal manner, as demonstrated by the change in integration weights when we manipulated the uncertainty of the post-saccadic target estimate by varying exposure time. Therefore, the brain predicts the sensory consequences of motor commands because it integrates its prediction with the actual sensory information to produce an estimate of sensory space that is better than possible from either source alone.

Adult↗