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PubMed1995

Atonic pupil after cataract surgery.

We report and describe the clinical findings of three patients who developed atonic pupil after uncomplicated extracapsular cataract extraction with posterior chamber intraocular lens implantation. All patients had normally reactive pupils one day postoperatively, but after two weeks, the pupils were dilated and nonreactive to light, accommodation, and miotics. To estimate the incidence of atonic pupil after cataract surgery, we sent a survey on the frequency, clinical features, and possible etiologies of this syndrome to members of the American Society of Cataract and Refractive Surgery. Of the 567 respondents, 60% had seen at least one case of atonic pupil in the past five years; they reported a total of 1543 cases during that time. This is probably a conservative figure since many cases undoubtedly go unnoticed because of a lack of visual disturbance. We believe this condition occurs more frequently than previously reported. The atonic pupil should be recognized as a possible complication of cataract surgery that should be included in the preoperative consent form.

Aged↗
PubMedDate not supplied

Infants with Down syndrome: a look at temperament.

INTRODUCTION: This research describes temperament characteristics of infants with Down syndrome who are 1 to 4 months old. In the literature children with Down syndrome have been stereotyped. It was hypothesized that temperament characteristics may be evident and unique in newborns with Down syndrome. METHOD: A standardized questionnaire, The Early Infancy Temperament Questionnaire, a cover letter, informed consent forms, and a brief explanation of the project were given to families with a newborn infant with Down syndrome. Thirty-two (families with infants with Down syndrome completed the study. RESULTS: Mean scores indicate that infants with Down syndrome are rated more active, less intense, more distractible, and have a tendency to demonstrate more approach behaviors compared with normally developing infants. Data suggest infants with Down syndrome have some unique characteristics but are more like their normally developing peers than different. DISCUSSION: Integration and mainstreaming of infants and children with Down syndrome emphasizes the need for nurse practitioners to appreciate the temperament characteristics of these infants.

Down Syndrome↗
PubMed2004

The role of subclinical paranoia on social perception and behavior.

The purpose of this study was to investigate the effects of subclinical paranoia on social perception and behavior. Two groups of participants, those high and low in subclinical paranoia, were identified based on extreme scores on the Paranoia Scale (PS). As expected, persons high in subclinical paranoia had greater depression, social anxiety, self-consciousness, and lower self-esteem compared to persons low in subclinical paranoia. In addition, persons high in subclinical paranoia performed worse than persons low in subclinical paranoia on laboratory measures of emotion perception and on an in vivo social perception task. Finally, behavioral differences between these two groups were revealed: Persons high in subclinical paranoia sat further away from the examiner and took longer to read the consent form than low-paranoia persons. These behavioral differences were not due to the group differences in clinical functioning, indicating that level of paranoia generally accounted for these findings.

Adult↗
PubMed2001

Sentinel lymph node biopsy as an indicator for axillary dissection in early breast cancer.

Sentinel node biopsy (SNB) is a new component of the surgical treatment of breast cancer that accurately predicts axillary status. Although the procedure is still mainly investigational, many patients are requesting SNB to avoid axillary dissection if the sentinel node (SN) is negative. From March 1996 to December 1999, 373 patients with breast carcinoma and clinically negative axillary nodes underwent breast surgery, mainly conservative, and SNB. If the SN was histologically uninvolved no further surgical treatment was given. All patients were informed in detail and signed a consent form. SNB involved injection of labelled albumin particles close to the primary tumour, lymphoscintigraphy and location of the sentinel node with a gamma probe during surgery. 379 SNBs were performed on 373 patients (6 were bilateral). In 94, the SN was positive and complete axillary dissection was performed. In 285 cases (280 patients) the SN was negative and no dissection was performed: these were carefully followed with quarterly clinical examination of the axilla. A total of 343 years at risk were available for evaluation from which seven cases of axillary metastases were expected. No cases of clinically evident axillary node metastasis have occurred. These findings provide further confirmation of the validity of SNB and prompt us to suggest that it should become the method of choice for axillary staging in small-sized breast cancer.

Adult↗
PubMed2003

The impact of nutrition intervention on a reliable morbidity and mortality indicator: the hemodialysis-prognostic nutrition index.

OBJECTIVE: To determine the prevalence of risk for hospitalization in hemodialysis (HD) patients and examine the impact of oral kilocalorie and protein supplementation in two Midwestern outpatient dialysis centers. DESIGN/SETTING: This was a prospective intervention study conducted at 2 outpatient dialysis centers in the Midwest. PATIENTS: The inclusion criteria for patients were (1) more than 18 years of age, (2) receiving HD 3 times per week, and (3) a functioning gastrointestinal tract. INTERVENTION: Patients who met study criteria and signed an informed consent form were screened using the hemodialysis prognostic nutrition index (HD-PNI) to determine risk for hospitalization. Patients determined to be at high risk (HD-PNI > or =0.8) were included in the treatment group, and patients at low risk did not receive the intervention. They followed their normal nutritional regimen. The intervention group received an oral supplement daily for 3 months. The team of the dietitian, patient, researcher, and physician determined the type of oral supplements based on patient needs and preferences. MAIN OUTCOME MEASURES: Before and after HD-PNI, 24-hour recall and subjective global assessments (SGA) were conducted to assess risk for hospitalization, dietary intake, and nutritional status, respectively. RESULTS: A total of 117 patients were screened, with a total of 26 in the treatment group (high risk) and 91 in the low-risk group. Baseline SGA distribution was 23% for patients with low nutritional risk (group A), 64% for those with moderate nutritional risk (group B), and 13% for those with severe nutritional risk (group C). When the HD-PNI scores of the treatment group were analyzed using paired t-tests, significant differences were observed between pre- and post-HD-PNI mean scores, 1.92 +/- 1.16 and 1.42 +/- 1.59, (P <.05) respectively. When comparing the responders versus the nonresponders by the dependent and independent variables (pre- and post-HD-PNI, SGA, kilocalorie intake, diabetic status, and presence of hypertension) only post-HD-PNI score was significantly different (0.96 +/- 1.69 and 2.20 +/- 1.09, respectively). CONCLUSION: This study succeeded in showing that 22% of the hemodialysis patients in 2 Midwestern centers were at an increased risk for hospitalization. Furthermore, dietitian intervention with oral kilocalorie and protein supplements decreased the patients' hemodialysis prognostic nutrition index scores and thereby decreased the patients' risks for hospitalization.

Aged↗
PubMedDate not supplied

Which fourth-grade children participate in school breakfast and do their parents know it?

OBJECTIVE: To explore fourth-graders' school breakfast participation by gender and race (black, white) and examine the extent to which parents' responses to "Does this child usually eat school breakfast?" reflected their children's participation. DESIGN: Parents answered "yes" or "no" to the questions printed on consent forms. Observers documented which children participated in school breakfast on 26 to 51 randomly selected days per school during 24 weeks in the 1999-2000 school year. SUBJECTS: 357 children recruited from all 22 fourth-grade classes from 6 schools in 1 public school district. VARIABLES MEASURED: Participation rate, participation rate grouping [usually participated (>or=50% of days observed), did not usually participate (< 50% of days observed)]. STATISTICAL ANALYSES PERFORMED: Komolgorov-Smirnov tests, McNemar's test. RESULTS: Median participation rate was 37.5% overall. Distribution of participation rates differed significantly by race (K-S test, P <.001) but not gender. There was a significant difference in the percentage of parents who said "yes" or "no" compared to children's usual participation grouping (McNemar test, P <.001). Of parents who said "yes," 66% of children usually participated; of parents who said "no," 92% of children did not usually participate. IMPLICATIONS: Children, not parents, must be the source for learning about what children eat at school.

Black or African American↗
PubMedDate not supplied

Vaginal birth after cesarean birth: a national survey of U.S. midwifery practice.

Midwives have been providing care for women choosing vaginal birth after cesarean birth (VBAC) for over 20 years. The 1999 American College of Obstetrician Gynecologist (ACOG) guidelines and recent studies questioning the relative safety of VBAC have raised concerns about continuing to offer this option. As part of an effort to understand VBAC care provided by midwives, this study used a national survey sample to examine practices, scope, and recent changes in the provision of VBAC care. The survey, which included demographic and practice items was mailed in late 2000 to a purposeful sample of 325 midwifery practices. The return rate was 62%. Nearly all (94%) of the responding practices were providing VBAC care, and almost half of them (43%) stated that their ability to do so had changed within the past 2 years secondary to recent studies in the obstetric literature, the 1999 ACOG statement, and concerns from third-party payers. Criteria for offering VBAC are stricter, and consent forms are more extensive. Other changes included the need for additional or more intensive support services, in-house anesthesia, and surgery backup. Midwives continue to provide VBAC care, although with some increased restrictions. This study provides background for future research that will determine how midwifery care affects the rate of successful VBACs.

Adult↗
PubMedDate not supplied

Client satisfaction: traditional care versus cluster care.

The purposes of this study were to describe and compare the level of satisfaction of clients receiving traditional care and those receiving cluster care. None of the studies reviewed described client satisfaction in the traditional and cluster care service delivery models using a reliable and valid instrument. The study sample consisted of 77 Medicaid-eligible elderly clients from three different home care agencies in an urban city. Of the 77 subjects, 37 (48 per cent) received cluster care, and 40 (52 percent) received traditional care. After receiving approval from the home health care agencies, subjects who agreed to participate in the study were asked to sign a consent form and to complete a demographic data sheet and the Gray's Home Care Satisfaction Scale (GHCSS). Internal consistency reliability for the GHCSS is 0.78, with content validity present. An independent student's t test showed a statistically significant difference in the level of satisfaction of clients receiving traditional care and cluster care (t = -5.27, P = .0005). Clients receiving traditional care had higher levels of satisfaction than clients receiving cluster care. Additional findings showed that men in both the traditional and cluster care groups were more satisfied than women (t = -3.19, P = .003 and t = -2.96, P = .007, respectively). Analysis of variance showed that blacks in both the traditional and cluster care groups had lower levels of satisfaction than either whites or Hispanics. Implications of study findings are discussed.

Aged↗
PubMed2002

Recruitment of older participants in frailty/injury prevention studies.

Despite the lifelong health benefits of physical activity, frailer older adults have typically been excluded from studies promoting more active lifestyles. This study documents the recruitment process and costs from a multisite study to identify effective strategies for recruiting older adults in frailty/injury prevention research. Randomized controlled clinical trials were conducted at 7 sites; an 8th site was a compliance study. Interventions reflected center- and home-based health promotion programs. Site objectives, eligibility criteria, and contact and screening methods were obtained from manuals of operation. Recruitment results (number screened, eligibility rates, randomized to screened ratios) were ascertained from recruitment data. Sites furnished estimated recruitment costs (nonlabor expenses, investigator and staff time, fringe benefits) up to signing the consent form. The sites targeted diverse populations and sample sizes. The majority revised recruitment methods to meet their recruitment goals. Most sites estimated costs of recruitment at over $300 per participant randomized. Recruitment costs were affected by staff time spent alleviating concerns about participants' health, essential interactions with family members, and arranging for transportation. Neither frailty nor intervention intensity was found to be a major predictor of recruitment outcomes. Recruitment expense was associated with selection criteria and frailty status of the target population. Older people can be successfully recruited into beneficial health promotion programs, but it is often challenging. In planning health promotion studies, investigators need to be aware of the numbers of older people they may need to screen and different strategies for increasing recruitment success.

Accidental Falls↗
PubMed2001

Non-response and related factors in a nation-wide health survey.

OBJECTIVE: To analyse selective factors associated with an unexpectedly low response rate. SUBJECTS AND METHODS: The baseline questionnaire survey of a large prospective follow-up study on the psychosocial health of the Finnish working-aged randomly chosen population resulted in 21,101 responses (40.0%) in 1998. The non-respondent analysis used demographic and health-related population characteristics from the official statistics and behavioural, physical and mental health-related outcome differences between early and late respondents to predict possible non-response bias. Reasons for non-response, indicated by missing responses of late respondents, and factors affecting the giving of consent were also analysed. RESULTS: The probability of not responding was greater for men, older age groups, those with less education, divorced and widowed respondents, and respondents on disability pension. The physical health-related differences between the respondents and the general population were small and could be explained by differences in definitions. The late respondents smoked and used more psychopharmaceutical drugs than the early ones, suggesting similar features in non-respondents. The sensitive issues had a small effect on the response rate. The consent to use a medical register-based follow-up was obtained from 94.5% of the early and 90.9% of the late respondents (odds ratio: 1.70; 95% confidence interval: 1.49-1.93). Consent was more likely among respondents reporting current smoking, heavy alcohol use, panic disorder or use of tranquillisers. CONCLUSIONS: The main reasons for non-response may be the predisposing sociodemographic and behavioural factors, the length and sensitive nature of the questionnaire to some extent, and a suspicion of written consent and a connection being made between the individual and the registers mentioned on the consent form.

Adult↗
PubMed1997

Prospective recruitment of women receiving prenatal care from diverse provider arrangements: a potential strategy.

OBJECTIVES: This study describes the use of a Medicaid managed care list to prospectively recruit into a research project pregnant women receiving care from a variety of providers. METHOD: A list of women enrolled in Medicaid managed care was used to recruit pregnant African-American and Latina women into a study of prenatal care satisfaction. Due to privacy concerns, the researchers were not able to directly access names from the list. Instead, a managed care contract agency sent recruitment letters to 1009 pregnant African-American and Latina Medicaid recipients. Response rates by ethnicity and several other key variables are calculated. The biases associated with this method of recruiting pregnant women from a variety of providers are discussed. RESULTS: Thirty-five percent of the women contacted returned consent forms and agreed to have researchers approach them; the response rate for African-American women was 43% and for Latinas was 29% (p < 0.0001). Respondents were younger and later in their pregnancies than nonrespondents, but did not differ from them by zip code of residence. The women recruited into the study obtained prenatal care from a diverse group of providers. CONCLUSIONS: While the use of a prospectively generated list of pregnant Medicaid recipients to recruit low-income pregnant women into a research study may be associated with some selection bias, the potential cost savings, decreased effort, and diminished recall bias may make their use a feasible sampling alternative, particularly when the researcher desires to recruit women seeking care from a variety of provider arrangements.

Adolescent↗
PubMed2003

Effects of trauma-focused research on recent domestic violence survivors.

This study investigated the impact of trauma-focused research on domestic violence survivors. At the end of a survey assessing psychological distress, abuse severity, coping self-efficacy (CSE), and cognitions, questionnaire items were utilized to assess participants' levels of gain, unexpected upset, and regret of participation. Participants were 55 women who had recently experienced abuse by a partner. Forty-five percent reported positive gain from participation, 25% reported they were more upset than anticipated, and a minority of women (6%) expressed regret for participation. Results indicated that women who were more upset than expected scored significantly higher on depression, PTSD, and number of lifetime traumas, and significantly lower on CSE. Implications for enhancement of consent form documents and debriefing procedures are addressed.

Adult↗
PubMed1996

A novel model system for the study of experimental guided bone formation in humans.

The aim of the present experiment was to test a novel model system, designed to obtain human specimens of regenerated and also newly regenerated jaw bone, for the study of the biological events under a variety of conditions. Following information and disclosure of possible risks associated with a minor oral surgical procedure, 9 systemically healthy subjects (5 men, 4 women, mean age 31.7 years) signed consent forms and volunteered to participate in this study. Hollow test cylinders with an outer diameter of 3.5 mm, an inner diameter of 2.5 mm, and 4 mm in height were used. They were manufactured from commercially pure titanium and exhibited a highly polished inner surface and a titanium plasma sprayed outer rough surface. A mucoperiosteal flap was raised in the retromolar area of the mandible corresponding to standard retrained third molar surgery. Following flap reflection a standardized hole was drilled through the cortical bone into the bone marrow using round burs. The congruent test cylinders were firmly placed into the prepared bony bed yielding primary stability. One-and-a-half to 2 mm of the test device were submerged below the level of the surrounding bone, while the remainder surpassed the level of the bone surface. The bone-facing end of the cylinder was left open, while the coronal soft tissue facing end was closed by an ePTFE-membrane. The flap was sutured to obtain primary wound closure. In order to prevent infection, penicillin was prescribed systemically and oral rinses of chlorhexidine were administered. After 2, 7, and 12 weeks one test device including the regenerated tissue was surgically harvested, while after 16, 24 and 36 weeks respectively, 2 devices were harvested and processed for soft or hard tissue histology or histochemistry. The two surgical procedures and the presence of the test cylinders during the time of healing were well tolerated by the volunteers. In all 9 subjects generated tissue could successfully be harvested. The tissue generated after 2 and 7 weeks presented with a cylindrical shape, whereas the specimens harvested at 12 weeks and thereafter resembled the form of an hourglass. Specimens of 12 weeks and less regeneration time were almost entirely comprised of soft tissue, while specimens with regeneration time of 4 months and more were composed of both soft and increasing amounts of mineralized tissue. It is concluded that the presented model system is suitable to study temporal dynamics and tissue physiology of bone regeneration in humans with minimal risk for complications or adverse effects to the volunteers.

Adult↗
PubMed2001

Acute effects of low doses of melatonin on the sleep of young healthy subjects.

This study was undertaken to evaluate the acute effects of single low doses of melatonin given to healthy volunteers in the evening. Six healthy male volunteers (age range 22-24 years) participated in this study, after signing an informed consent form. They received in a double-blind fashion placebo or 0.3 or 1.0 mg melatonin at three fixed times: 18:00, 20:00, and 21:00 hr. Polysomnographic recordings began immediately thereafter, with their being allowed to sleep. Prior to each experimental session and in the following morning, subjects completed a sleep quality questionnaire, the Profile of Mood States, the Stanford Sleepiness Scale, and underwent a visual reaction test. Significant decrease on sleep latencies was found following melatonin treatment at 18:00 and 20:00 hr. In addition, melatonin tended to improve sleep efficiency and to reduce intermittent wakefulness. However, at 21:00 hr, 0.3 mg melatonin increased latency to sleep onset and 1.0 mg melatonin had no effect on sleep variables. Furthermore, melatonin given at different times did not alter subjective sleepiness, mood, and reaction time in the following morning. The results from the present study support the notion that administration of low doses of melatonin, mimicking the nocturnal physiological concentration of this hormone may exert immediate sleep-inducing effects.

Adult↗
PubMed1999

Cord blood banking in London: the first 1000 collections.

The London Cord Blood Bank was established with the aim of collecting, processing and storing 10000 unrelated stem cell donations for the significant number of children in the UK requiring transplantation, for whom a matched unrelated bone marrow donor cannot be found. Collection is performed at two hospitals by dedicated cord blood bank staff after delivery of the placenta. Mothers are interviewed regarding medical, ethnic and behavioural history by nurse counsellors and sign a detailed consent form. Donations are returned to the bank for processing. Volume reduction is undertaken by a simple, closed, semi-automated blood processing system, with excellent recovery of progenitor cells. Units are cryopreserved and stored in the vapour phase of liquid nitrogen. Blood samples from mothers and cord blood donations are tested for the UK mandatory red cell and microbiology markers for blood donors. Donations are typed for HLA-A, B and DR at medium resolution (antigen split) level using sequence-specific oligonucleotide probing and sequence-specific priming techniques. The selection of collection hospitals on the basis of ethnic mix has proven effective, with 41.5% of donations derived from non-European caucasoid donors. Bacterial contamination of collections has been dramatically reduced by implementation of improved umbilical cord decontamination protocols.

Blood Banks↗
PubMed2006

An observational study of laterality errors in a sample of clinical records.

BACKGROUND: Confusing left with right eyes can have a potentially serious adverse outcome. The most extreme occurrence is wrong site surgery but even potentially less serious errors can undermine patient confidence in their medical care. This study was designed to look into how often this could be detected in clinical notes. METHODS: An observational study conducted in an ophthalmic hospital. Hundred patients were randomly selected and their clinical notes retrieved. Notes were analysed for the number of left/right transpositions, which part of the notes they were found and whether they were corrected. RESULTS: Forty-four transposition errors were found in 32 sets on notes. The commonest error was drawing the eye on the wrong side of the page. The commonest place where errors were found was in the written outpatient notes. Nineteen of the errors had evidence of later correction. Three consent forms had the incorrect eye denoted and one patient was listed for surgery on the wrong side although this error was corrected before the operation. CONCLUSION: As far as we are aware, this study is the first to look at how often, in standard clinical notes, left/right transposition occurs. Although a direct link cannot made between their occurrence and later wrong side surgery, intuitively it would be reasonable to think it could increase the likelihood if other defences were to fail. We make a number of recommendations that might reduce this confusion and therefore more serious consequences.

Handwriting↗
PubMed1999

Patients' perception of surgical services in a district general hospital.

BACKGROUND: In addition to studying the outcomes of surgery in terms of mortality and morbidity rates and performance, it is also important to consider how patients perceive the delivery of the service given to them. METHODS: A patient satisfaction survey was carried out by the Surgical Epidemiology and Audit Unit of the Royal College of Surgeons of England, on patients undergoing surgical procedures by the Department of Surgery at Wrexham Maelor Hospital. No day cases were included in the study. Two hospitals in southern England (undergoing the same survey) designated X and Y were used for comparison. RESULTS: Some 2000 questionnaires were sent out twice; 1666 subjects (83 per cent) responded to the first questionnaire and 1445 (87 per cent) of these responded to a second questionnaire 6 weeks later (overall response 72 per cent). A total of 35 per cent of patients were older than 65 years of age. Some 76 per cent of patients with a malignant condition were seen within 4 weeks of referral compared with 38 per cent of those with a benign condition (P < 0.0001). A total of 78 per cent of patients with cancer were admitted within 4 weeks compared with 84 and 88 per cent in hospitals X and Y. Some 23 per cent of patients were admitted as an emergency. Eighteen per cent of patients did not know who presented a consent form to them before surgery compared with 13 and 17 per cent in hospitals X and Y (P < 0.0001). Some 26 per cent of patients perceived that they had complications after surgery compared with 27 and 25 per cent for hospitals X and Y. A total of 35 per cent of patients did not receive a follow-up appointment and 20 per cent of these patients were unhappy about this. Two areas of major concern revealed by the responses were the lack of written information and the overall poor scores generally attained by the emergency admission ward. However, 94 per cent of patients said that they would return to the same consultant. CONCLUSION: Patients were generally happy with their surgical care and there was little difference between the three hospitals studied. Lower scores were given when patients were admitted to emergency admission wards. Higher scores were given when patients received printed information.

Adolescent↗
PubMed2003

Demand for nursing competencies: an exploratory study in Taiwan's hospital system.

Along with increasing complexity of nursing services, hospital employers are demanding qualified and competent staff nurses for high quality clinical care. In Taiwan, disparities in the demand for competent nurses by employers and the supply produced by nursing educators still exist and require attention. A comprehensive understanding of the specific needs of Taiwan's medical care system for nursing services would help bridge the current gap between demand for and supply of competently trained nurses. This exploratory study investigated hospital employers' perceptions of the extent to which the nursing skills identified by Cleary et al. [Image: Journal of Nursing Scholarship (1998)20(4):39-42] were needed for staff nurses in Taiwan's medical care system. There were a total of 21 nursing competencies and classification on these items was also implemented. A cross-sectional, quantitative, survey design was conducted. Subjects' participation was voluntary, an information leaflet and an informed consent form was included in the questionnaire. A total of 89 nursing employers (nursing directors, associate directors, supervisor, or head nurse) participated, resulting in a 42.6% response rate. Factor analysis grouped these skills into three factors: basic-level patient care, intermediate-level patient care and basic management, and advanced-level patient care and supervision. This study confirmed that levels of nursing competencies needed differed by type of hospital accreditation. These levels also varied depending on types of services provided, employers' professional titles and tenure of currently employed nurses. The questionnaire developed for this study could be used as one of the tools to communicate demand and supply of nursing competencies between nurse educators and employers. These competencies could be used to develop a checklist for evaluating adequacy of nursing programmes in order to meet nurses' new roles and responsibilities and improve nursing care quality in the fast-changing health care environment in Taiwan.

Adult↗