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PubMed2005

Inmate exposure to secondhand smoke in correctional facilities and the impact of smoking restrictions.

This study was undertaken to measure the passive smoking exposure of prisoners at three correctional facilities in the US and to evaluate the effectiveness of a ban on smoking in reducing these exposures at two of these facilities. The average weekly concentration of nicotine was measured in fixed locations within the correctional facilities using passive samplers. Samples were collected before and after a smoking ban was instituted, and after the policy was modified to allow smoking outdoors. Samples were collected in the living areas, near where inmates slept and watched TV, and in selected central facilities, including dining halls, visiting rooms, booking areas, and learning centers. Average weekly concentrations of nicotine were measured in 84 locations while smoking was allowed; changes in these concentrations were measured with 112 weekly samples 4 and 9 months after the policy restricting smoking was implemented The average concentrations of nicotine were high while smoking was allowed: most living and sleeping areas averaged 3-11 microg/m(3), but the gym that was used as a bunkroom averaged 25 microg/m(3); these values compare to an average of 2 microg/m(3) in the homes of smokers. The smoking ban significantly reduced nicotine concentrations in the living areas (P<0.01 at facility A and P<0.05 at facility B) to averages of 1.5-2.2 microg/m(3); all postban samples were less than 5 microg/m(3). In conclusion, secondhand smoke concentrations in correctional facilities can be quite high; however, policies banning smoking are effective in reducing, but not eliminating, these exposures.

Activities of Daily Living↗
PubMed2000

Multiple organ dysfunction syndrome: exploring the paradigm of complex nonlinear systems.

OBJECTIVES: The objectives of this article are to introduce and explore a novel paradigm based on complex nonlinear systems, and to evaluate its application to critical care research regarding the systemic host response and multiple organ dysfunction syndrome (MODS). DATA SOURCES: Published original work, review articles, scientific abstracts and books, as well as our personal files. STUDY SELECTION: Studies were selected for their relevance to the applications of nonlinear complex systems, to critical care medicine, and to the concepts presented. DATA EXTRACTION: We extracted all applicable data. DATA SYNTHESIS: Following a brief review of MODS, an introduction to complex nonlinear systems is presented, including clear concepts, definitions, and properties. By examining the multiple, nonlinear, interrelated, and variable interactions between the metabolic, neural, endocrine, immune, and inflammatory systems; data regarding interconnected antibody networks; and the redundant, nonlinear, interdependent nature of the inflammatory response, we present the hypothesis that the systemic host response to trauma, shock, or sepsis must be evaluated as a complex nonlinear system. This model provides a new explanation for the failure of trials using various antimediator therapies in the treatment of patients with sepsis and MODS. Understanding the host response as a complex nonlinear system offers innovative means of studying critical care patients, specifically by suggesting a greater focus on systemic properties. We hypothesize that analysis of variability and connectivity of individual variables offer a novel means of evaluating and differentiating the systemic properties of a complex nonlinear system. Current applications of evaluating variability and connectivity are discussed, and insights regarding future research are offered. CONCLUSION: The paradigm offered by the study of complex nonlinear systems suggests new insights to pursue research to evaluate, monitor, and treat patients with MODS.

Critical Care↗
PubMedDate not supplied

Using cluster analysis for medical resource decision making.

Escalating costs of health care delivery have in the recent past often made the health care industry investigate, adapt, and apply those management techniques relating to budgeting, resource control, and forecasting that have long been used in the manufacturing sector. A strategy that has contributed much in this direction is the definition and classification of a hospital's output into "products" or groups of patients that impose similar resource or cost demands on the hospital. Existing classification schemes have frequently employed cluster analysis in generating these groupings. Unfortunately, the myriad articles and books on clustering and classification contain few formalized selection methodologies for choosing a technique for solving a particular problem, hence they often leave the novice investigator at a loss. This paper reviews the literature on clustering, particularly as it has been applied in the medical resource-utilization domain, addresses the critical choices facing an investigator in the medical field using cluster analysis, and offers suggestions (using the example of clustering low-vision patients) for how such choices can be made.

Algorithms↗
PubMedDate not supplied

Effects of distraction on pain, fear, and distress during venous port access and venipuncture in children and adolescents with cancer.

This study evaluates the effect of self-selected distracters (ie, bubbles, I Spy: Super Challenger book, music table, virtual reality glasses, or handheld video games) on pain, fear, and distress in 50 children and adolescents with cancer, ages 5 to 18, with port access or venipuncture. Using an intervention-comparison group design, participants were randomized to the comparison group (n = 28) to receive standard care or intervention group (n = 22) to receive distraction plus standard care. All participants rated their pain and fear, parents rated participant fear, and the nurse rated participant fear and distress at 3 points in time: before, during, and after port access or venipuncture. Results show that self-reported pain and fear were significantly correlated (P = .01) within treatment groups but not significantly different between groups. Intervention participants demonstrated significantly less fear (P <.001) and distress (P = .03) as rated by the nurse and approached significantly less fear (P = .07) as rated by the parent. All intervention parents said the needlestick was better because of the distracter. The authors conclude that distraction has the potential to reduce fear and distress during port access and venipuncture.

Adolescent↗
PubMed2004

The pathogenesis and characterization of oral mucositis associated with cancer therapy.

PURPOSE/OBJECTIVES: To describe the current knowledge about the pathogenesis of oral mucositis associated with cancer therapy and oral mucositis. DATA SOURCES: Published research and literature review articles, books, and posters of findings that have been selected for presentation at research conferences. DATA SYNTHESIS: Aggressive cancer treatment yields gains in cure or sustained control but also in oral complications, including oral mucositis. Recent work suggests that oral mucositis involves a series of biologically and physiologically complex cellular and tissue interactions that vary in accordance with treatment type and characteristics. CONCLUSIONS: The impact of treatment-related oral mucositis in patients is multifaceted and can significantly affect patients' experiences in terms of morbidity and treatment course. The creation of effective, targeted management strategies ultimately relies on a better understanding of the biologic processes underlying oral mucositis development coupled with systematic use of assessment tools. IMPLICATIONS FOR NURSING: Incorporating current knowledge about the pathogenesis of oral mucositis with regular use of available assessment instruments can help to ensure prompt recognition of oral manifestations and facilitate better treatment strategies.

Antineoplastic Agents↗
PubMed2004

[Kangaroo-Mother Care: scientific evidence and impact on breastfeeding].

OBJECTIVE: To describe the history of the Kangaroo Mother Care and present scientific evidence about benefits of this practice on morbidity and mortality, psychological and neurological development and breastfeeding of low birth weight infants. SOURCES OF DATA: Papers about Kangaroo Mother Care published from 1983 to 2004 were consulted, selected in Medline and Lilacs, as well as books, thesis and technical publications from the Brazilian Health Department. SUMMARY OF THE FINDINGS: Since its first description, Kangaroo Mother Care has been extensively studied. The analysis of randomized trials showed that it consists in a protection factor to breastfeeding at discharge (relative risk 0.41, 95% confidence interval 0.25 to 0.68). The method was always associated with the following reduced risks: nosocomial infection at 41 weeks' corrected gestational age (relative risk 0.49, 95% confidence interval 0.25 to 0.93), severe illness (relative risk 0.30, 95% confidence interval 0.14 to 0.67), lower respiratory tract disease at 6 months (relative risk 0.37, 95% confidence interval 0.15 to 0.89) and better gain of weight per day (weighted mean difference 3.6 g/day, 95% confidence interval 0.8 to 6.4). Psychomotor development at 12 months' corrected age was similar in the two groups. There was no evidence of a difference in infant's mortality. CONCLUSIONS: A positive impact of Kangaroo Mother Care on breastfeeding was found. Although the method appears to reduce severe infant morbidity without any serious deleterious effect reported, there is still insufficient evidence to recommend its routine use. It is necessary to develop studies about effectiveness, acceptability and applicability of the method in the Brazilian context.

Brazil↗
PubMed1977

Deliberate presleep control of dream content: an experimental study.

29 subjects attempted, over a period of 10 nights, to influence their dream using techniques described in Garfield's book, Creative Dreaming (1974). A target suggestion was selected from a list of six suggestions compiled by, or for, each subject. Subjects kept daily records during the experiment both of their efforts at dream influence and of the dreams they recalled. Four judges attempted to identify from the dream material the target suggestion on each subject's suggestion list. The results indicated that the judges were unable to do so at better than chance levels. Thus analysis indicated no reliable evidence that conscious presleep suggestions become incorporated into dream content.

Autosuggestion↗
PubMed1993

Information sources for medical waste management.

Although many hospital professionals now have personal access to online databases, popular communications services may not have the full range of electronic services needed for technical problem solving. Librarians are practiced at cross-disciplinary technical research and so health professionals may be best served by consulting an experienced database search analyst so that important information is not accidentally missed. Additionally, many commercially produced databases have repackaged and redistributed data developed by NIOSH and other federal agencies, data that are readily available in the public sector. The cost of accessing or purchasing commercial databases is usually higher than for federal databases, though commercial products use the federal databases to develop their products. Public agencies should always be consulted to obtain the most current information issued by those bodies and also because a variety of free and low-cost support materials may be available. Because of the expense of routinely consulting electronic databases when comparable printed materials may be available at a lower cost, a small reference collection of books, journals, and audiovisuals may be desirable. A selective print reference collection is found in Appendix A.

Databases, Bibliographic↗
PubMed1993

Prescription assistance programs: options for assisting the uninsured and underinsured.

The objectives of the study were to determine the prevalence of indigent patient or reimbursement assistance programs for prescription drugs sponsored by the pharmaceutical industry and to collect data describing them. A questionnaire was mailed to 121 manufacturers or marketers of prescription drugs selected from the 1990 edition of the Red Book and 1991 edition of the Physicians' Desk Reference. The availability of free drug to qualified indigent patients or the availability of experts to solve reimbursement issues was then ascertained. The general application procedures and features of both types of programs were documented. The authors found that indigent patient and reimbursement assistance programs are offered for many products by numerous pharmaceutical companies, although not always on a formal basis. Of the 69 (57%) companies responding to the survey, 46 (67%) offer indigent patient assistance programs and 31 (45%) offer reimbursement assistance programs. Application procedures and services provided vary considerably between companies. These findings suggest that the pharmaceutical industry is a potential source of assistance in procuring drugs for the indigent or underinsured patient populations and a resource for resolving insurance issues. It is essential to contact a sponsor to determine current program availability and application procedures. Further study is required to appraise the merit of such programs.

Directories as Topic↗
PubMedDate not supplied

Clinical applications of flow cytometry.

OBJECTIVE: To describe the basics of three clinical applications of the flow cytometer. DATA SOURCES: Recent articles and books on flow cytometry and laboratory diagnosis. STUDY SELECTION: Not applicable. DATA EXTRACTION: Performed by the author. DATA SYNTHESIS: Immunophenotyping is the classification of cells based on antigens present on their surfaces. These antigens can be detected and quantified by a flow cytometer using monoclonal antibodies conjugated to fluorescent dyes. Reticulocytes are immature red blood cells that contain varying amounts of RNA and DNA. They can be stained with a fluorescent dye and enumerated by a flow cytometer. DNA ploidy analysis of solid tumors involves staining the nuclei of cells with a fluorescent dye. The amount of DNA in each cell is determined, and the percentage of cells in the S phase is calculated. CONCLUSION: Flow cytometry is a relatively new technology in the clinical laboratory. There are many clinically useful applications for which it is suited. As the technology continues to grow, so will the use of the flow cytometer.

Blood Cell Count↗
PubMed1999

Collection development and outsourcing in academic health sciences libraries: a survey of current practices.

Academic health sciences libraries in the United States and Canada were surveyed regarding collection development trends, including their effect on approval plan and blanket order use, and use of outsourcing over the past four years. Results of the survey indicate that serials market forces, budgetary constraints, and growth in electronic resources purchasing have resulted in a decline in the acquisition of print items. As a result, approval plan use is being curtailed in many academic health sciences libraries. Although use of blanket orders is more stable, fewer than one-third of academic health sciences libraries report using them currently. The decline of print collections suggests that libraries should explore cooperative collection development of print materials to ensure access and preservation. The decline of approval plan use and the need for cooperative collection development may require additional effort for sound collection development. Libraries were also surveyed about their use of outsourcing. Some libraries reported outsourcing cataloging and shelf preparation of books, but none reported using outsourcing for resource selection. The reason given most often for outsourcing was that it resulted in cost savings. As expected, economic factors are driving both collection development and outsourcing practices.

Budgets↗
PubMed1999

Nutrition in the management of acquired immunodeficiency syndrome.

OBJECTIVE: To highlight the influence of nutrition on the progress of HIV/AIDS and the role and importance of good nutrition in the management of the disease. STUDY SELECTION: The subject was selected because it is now recognised that nutritional care and support is an essential component of the health care plan and management for people with HIV/AIDS. The subject is especially relevant since few studies have been conducted locally on the effects of nutritional status on the progression of HIV/AIDS. DATA RESOURCES AND DATA SYNTHESIS: A review of current literature selected from local and international scientific journals and books on the subject of nutrition and HIV/AIDS. DATA EXTRACTION AND SYNTHESIS: Data were developed from the reviewed information extracted from the contribution of different authors who are interested in nutritional management of people with HIV/AIDS. It was then analysed and synthesised into the current article. CONCLUSION: On the basis of the reviewed information, it is recommended that individuals with HIV/AIDS be given nutrition counselling and support to enable them achieve an adequate nutrient and energy intake for as long as possible. This would enhance the quality of their lives and minimise disease symptoms.

Acquired Immunodeficiency Syndrome↗
PubMed1992

A prospective study on some factors which influence the delivery of low birth weight babies in a developing country.

The study was prospective in design and carried out in Ibadan, Nigeria. It was undertaken in order to provide more information on the low birth weight deliveries seen here and to evaluate some factors associated with their births. 600 randomly selected gravid women who presented to the antenatal booking clinics for the first time in this pregnancy were followed up till delivery of their babies. Data on 492 women who produced normal, singleton babies were analysed. The mean birth weight was 3167g +/- 451g (males; 3205g +/- 469g and significantly higher than of females of 2991g +/- 468g). The incidence of low birth weight (LBW) weight of 2500g and less was 8.3% and comprised of 18 males, 22 females and 1 unknown sex. 80% of these LBW babies were term (37-41 wks gestation) at delivery, while 20% were pre-term (< 37 wks). There was seasonal variation in the incidence of LBW, the risk being highest during the peak of dry season and lowest during the rainy season. The mothers age, parity, height, ponderal index at delivery, and total maternal weight gain as well as birth interval were each significantly related to the incidence of LBW in these mothers (P < 0.01). Maternal education as well as socio-economic class were not significant (P > 0.5).

Adolescent↗
PubMedDate not supplied

Autologous bone marrow transplantation in acute lymphoblastic leukemia: biological and clinical aspects.

The purpose of this review is to assess the current status of autologous bone marrow transplantation in acute lymphoblastic leukemia. In the first part of the review the biological aspects of minimal residual disease are discussed and in the second part the most recent clinical results analyzed. Only the studies that contained adequate response and survival data were selected for analysis, including peer-reviewed articles, book chapters and proceedings of international meetings. The most current or complete references were used for series reported more than once.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1996

The wired physician: current clinical information on the Internet.

The Internet and associated World Wide Web are electronic technologies that can help physicians identify needed clinical information quickly and can put physicians in ready contact with other specialists for communication and consultation. This article outlines the kinds of resources available on the Internet and methods for connecting your personal computer to the "information superhighway." Selected Internet sites and a short bibliography of books and articles relating to the Internet are included.

Computer Communication Networks↗
PubMed1995

Hodgkin's disease: basing treatment decisions on prognostic factors.

The purpose of this study was to review the current status of risk factor assessment in Hodgkin's disease (HD) clinically useful for managing this disease. Regarding database retrieval and selection a literature search restricted to English-language articles, abstracts, book chapters and reports published between 1980 and 1993 was conducted both electronically using MEDLINE and CANCERLIT and manually using the bibliographies of the retrieved database. Out of approximately 500 publications identified for analysis, 34 were selected as illustrative. Results showed that most patients with Hodgkin's disease are curable at the outset with standard radio- or chemo-therapy, depending on stage and other risk factors. However, up to 40% of patients will either fail at initial induction, or experience early or late relapses. Risk factors analysis at these various times provide a solid base for selecting the therapy best suited to optimize outcome for each individual patient. Patients with truly refractory disease pose a serious challenge to clinicians and are best managed in specialized centers conducting controlled clinical trials. In conclusion it appears that although approximately 75% of newly diagnosed patients with HD can expect long-term, disease-free survival, refractory patients exhibit a dismal survival. Improving their outcome will require innovative approaches.

Combined Modality Therapy↗
PubMed1999

Clinical effects of raloxifene hydrochloride in women.

PURPOSE: To review clinical data on raloxifene hydrochloride, a selective estrogen receptor modulator that was recently approved for the prevention of osteoporosis in postmenopausal women. DATA SOURCES: English-language articles published from 1980 to May 1998 were identified through MEDLINE searches. Bibliographies, book chapters, and meeting abstracts were reviewed for additional relevant publications. STUDY SELECTION: Publications that contained information on the background of development, structure, mechanism of action, tissue-selective effects, and adverse effects of raloxifene hydrochloride were included. DATA EXTRACTION: Data in selected articles were reviewed, and relevant clinical information was extracted. DATA SYNTHESIS: Raloxifene hydrochloride was developed in an effort to find a treatment for breast cancer and osteoporosis. It binds to the estrogen receptor and shows tissue-selective effects; thus, it belongs to a class of drugs recently described as selective estrogen receptor modulators. Tissue selectivity of raloxifene may be achieved through several mechanisms: the ligand structure, interaction of the ligand with different estrogen receptor subtypes in various tissues, and intracellular events after ligand binding. Raloxifene has estrogen-agonistic effects on bone and lipids and estrogen-antagonistic effects on the breast and uterus. An increase in bone mineral density at the spine, total hip, and total body has been reported with raloxifene but seems to be less than that seen with estrogen or alendronate therapy. Raloxifene has been shown to produce a reduction in total and low-density lipoprotein cholesterol concentrations similar to that produced by estrogen therapy, but high-density lipoprotein cholesterol and triglyceride concentrations do not increase during raloxifene therapy. In the uterus, raloxifene does not stimulate the endometrium. Long-term data on the effects of raloxifene in reduction of risk for fracture; prevention of cardiovascular events; cognitive function; and the incidence of breast, ovarian, and uterine cancer are not available. The most common adverse effect of raloxifene is hot flashes. CONCLUSIONS: Raloxifene has been shown to have beneficial effects in selected organs in postmenopausal women. Although estrogen remains the drug of choice for hormonal therapy in most postmenopausal women, raloxifene may be an alternative in certain groups of women at risk for osteoporosis.

Animals↗