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PubMed1997

Community-acquired pneumonia in old age: a prospective study of 91 patients admitted from home.

OBJECTIVE: to characterize the background, aetiology, clinical course and outcome of community-acquired pneumonia (CAP) in elderly compared with younger patients. DESIGN: a 1 year prospective study. SETTING: a university hospital in southern Israel. PARTICIPANTS: ninety-one patients over 65 years who were hospitalized from their homes with CAP. These patients were compared with a reference group of 54 CAP patients, aged 55-64 years. MEASUREMENTS: an intensive work-up (primarily serological) to identify the aetiological causes of CAP. The age groups were compared in terms of variables related to CAP. RESULTS: the proportion with pneumococcal infection, the most common aetiology for CAP, increased from 29.6% in the 55-64-year group through 45.6% in the 65-74-year group; up to 57.8% in the 75+ group (P = 0.019). Chlamydia pneumoniae was identified as the aetiological agent in 26.4% of elderly patients. Mortality in patients > or = 75 years was 20% and was significantly higher than in the two younger age groups (P = 0.019). The leucocyte count was significantly higher among the elderly group (P = 0.013) and the serum urea concentration was higher in patients 75 years and older (P = 0.025). The proportion of patients treated with antibiotics before admission decreased with increasing age (P = 0.026). CONCLUSIONS: CAP has more serious clinical and abnormal laboratory features in the elderly than younger patients, particularly in those over 75. In independent elderly people, the pneumococcus is the most common causative agent for CAP but other agents, particularly C. pneumoniae, are common. Initial antibiotic treatment for these patients should therefore include a macrolide.

Aged↗
PubMed1984

Guidelines for exercise therapy of the elderly after myocardial infarction.

We have previously demonstrated that elderly male cardiac patients benefit from participation in early exercise programmes through enhancement of functional capacity and improved psychological responses to exertion. Based on our experience, we present guidelines for early exercise therapy in elderly cardiac patients. It appears that no special considerations need be made to reduce risk beyond those precautions already present in a standard programme for younger patients. In general, it is recommended that exercise therapy in the elderly utilize 70-85% of maximal heart rate, 3 days per week for 40 min per session. Specific modifications include: decreasing intensity of work on certain modalities due to limitations of specific muscle groups, increasing frequency of exercise sessions for persons with particularly low functional capacity, and emphasizing flexibility exercises which should also be included in the regular exercise therapy sessions. Our experience has indicated that elderly cardiac patients have little problem with adherence and safety in the exercise programme and that standard methods of exercise prescription can be utilized with only minor modifications.

Aged↗
PubMed1996

Endothelial control of the cardiovascular system: recent advances.

The endothelium is uniquely positioned at the interface between the blood and the vessel wall. As such, it performs multiple functions: It is involved in the regulation of coagulation, leukocyte adhesion in inflammation, vessel tone, and vascular smooth muscle cell growth, and also acts as a barrier to transvascular flux of liquids and solutes. Far from being a passive participant in these events, it is a dynamic tissue, secreting and modifying vasoactive substances, influencing the behavior of other cell types, and regulating extracellular matrix production and composition. During the past 20 years, the endothelium has been the focus of intense experimental work, resulting in the evolution of a new appreciation of its potential role in vascular disease. This review will concentrate on several areas of endothelial biology in which our knowledge of the molecular mechanisms regulating the function of the endothelium has expanded considerably, permitting new insights into the pathogenesis of vascular disease.

Animals↗
PubMed2001

Advance care planning: pitfalls, progress, promise.

We now have a decade of experience with advance directives since the Patient Self-Determination Act was signed into law in November 1990. With few exceptions, empirical studies have yielded disappointing results. Advance directives are recorded by medical personnel more often but are not completed by patients more frequently. The process of recording them does not enhance patient-physician communication. When available, advance directives do not change care or reduce hospital resources. The most ambitious study of advance care planning, the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments, failed to show any change in outcomes after an extensive intervention. Investigators have attempted to identify the reasons why the optimism about the Patient Self-Determination Act has not been realized. Many interventions to facilitate advance care planning were focused on specific treatment decisions. Recent research suggests that preferences for care are not fixed but emerge in a clinical context from a process of discussion and feedback within the network of the patient's most important relationships. Clinical trials emphasizing this approach have been successful. The approach that emphasizes communication, building trust over time, and working within the patient's most important relationships offers a hopeful model for clinicians working in intensive care units.

Advance Directives↗
PubMed1994

Work redesign in the neonatal intensive care unit: role development and training from an educational perspective.

This article addresses educational perspectives in the neonatal intensive care unit patient care restructuring process at University Medical Center (UMC), Tucson, Arizona. An overview of patient care restructuring concepts and the specifics of the UMC model are discussed. The role of assistive personnel in the NICU is reviewed in light of available guidelines and position statements. Strategies to facilitate the NICU restructuring process and evaluation mechanisms used are listed. The curriculum development process for training of the respiratory therapist in an expanded nursing support role is described, and critical aspects of the orientation plan are identified.

Education, Nursing, Continuing↗
PubMed1989

Reviewing nursing stress according to a proposed coping-adaption framework.

Is stress a common problem for nurses who work in intensive care units (ICUs)? Stress-coping theory is useful in analyzing ineffective coping and its outcome, burnout. This article compares stress among nurses in ICUs to stress in non-ICU nurses. Effects of stresses, such as nursing dissatisfaction and the loss of nurses to the profession, will be discussed. Research and commentaries regarding stress in ICU nurses v non-ICU nurses will be reviewed. Areas for future research will be presented.

Adaptation, Psychological↗
PubMed1999

Carbohydrate and exercise.

Total body carbohydrate stores are limited, and are often less than the carbohydrate requirements of athletic training and competition. However, the availability of carbohydrate as a substrate for muscle metabolism is a critical factor in the performance of both high-intensity intermittent work and prolonged aerobic exercise. The rate of carbohydrate oxidation during exercise is tightly regulated, with glucose availability closely matching the needs of the working muscles. Both the absolute and relative work rate play important roles in the regulation of substrate metabolism: carbohydrate-based fuels predominate at moderate to high power outputs, with muscle glycogen and glucose utilization scaling exponentially to the relative work rate. As such, strategies to maintain or enhance carbohydrate availability, such as the ingestion of carbohydrate before, during and after exercise, are critical to the performance of a variety of sports events, and are a key recommendation in current sports nutrition guidelines.

Carbohydrate Metabolism↗
PubMed2006

Current developments in peanut allergy.

PURPOSE OF REVIEW: Peanut allergy is among the most serious, life-threatening food sensitivities, and recent studies indicate increasing prevalence, particularly among children. Our objective is to highlight recent advances in the immunology and treatment of peanut allergy. RECENT FINDINGS: Peanut sensitization may be both a Th1- and Th2-driven process, and cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) may play a role in regulating the response intensity. Preliminary work shows that the food matrix is important in the immune response to peanut and that purified peanut allergens may have little intrinsic stimulatory capacity. Studies characterizing peanut allergens have revealed Ara h 1 and Ara h 2 as the most potent allergens, but Ara h 3 may be more allergenic than previously thought. There appears to be a relationship between the diversity of IgE-binding patterns and the severity of clinical symptoms. Multiple novel approaches to treatment are being investigated, which include traditional Chinese medicine, various forms of modified immunotherapy and the use of adjuvants in modified immunotherapy. SUMMARY: By understanding the immunologic response to peanut and the roles of the major peanut allergens, it may be possible to predict those at risk for severe reactions, prevent peanut sensitization and effectively treat those already sensitized.

Allergens↗
PubMed2006

Education by general practitioners or education and exercises by physiotherapists for patients with whiplash-associated disorders? A randomized clinical trial.

STUDY DESIGN: Randomized clinical trial. OBJECTIVE: To compare the effectiveness of education and advice given by general practitioners (GPs) with education, advice, and active exercise therapy given by physiotherapists (PTs) for patients with whiplash-associated disorders. SUMMARY OF BACKGROUND DATA: Available evidence from systematic reviews has indicated beneficial effects for active interventions in patients with whiplash-associated disorders. However, it remained unclear which kind of active treatment was most effective. METHODS: Whiplash patients with symptoms or disabilities at 2 weeks after accident were recruited in primary care. Eligible patients still having symptoms or disabilities at 4 weeks were randomly allocated to GP care or physiotherapy. GPs and PTs treated patients according to a dynamic multimodal treatment protocol primarily aimed to increase activities and influence unfavorable psychosocial factors for recovery. We trained all health care providers about the characteristics of the whiplash problem, available evidence regarding prognosis and treatment, and protocol of the interventions. The content of the information provided to patients during treatment depended on the treatment goals set by the GPs or PTs. Also, the type of exercises chosen by the PTs depended on the treatment goals, and it was not explicitly necessary that exercise therapy was provided in all patients. Primary outcome measures included neck pain intensity, headache intensity, and work activities. Furthermore, an independent blinded assessor measured functional recovery, cervical range of motion, disability, housekeeping and social activities, fear of movement, coping, and general health status. We assessed outcomes at 8, 12, 26, and 52 weeks after the accident. RESULTS: A total of 80 patients were randomized to either GP care (n = 42) or physiotherapy (n = 38). At 12 and 52 weeks, no significant differences were found concerning the primary outcome measures. At 12 weeks, physiotherapy was significantly more effective than GP care for improving 1 of the measures of cervical range of motion (adjusted mean difference 12.3 degrees ; 95% confidence interval [CI] 2.7-21.9). Long-term differences between the groups favored GP care but were statistically significant only for some secondary outcome measures, including functional recovery (adjusted relative risk 2.3; 95% CI 1.0-5.0), coping (adjusted mean difference 1.7 points; 95% CI 0.2-3.3), and physical functioning (adjusted mean difference 8.9 points; 95% CI 0.6-17.2). CONCLUSIONS: We found no significant differences for the primary outcome measures. Treatment by GPs and PTs were of similar effectiveness. The long-term effects of GP care seem to be better compared to physiotherapy for functional recovery, coping, and physical functioning. Physiotherapy seems to be more effective than GP care on cervical range of motion at short-term follow-up.

Adult↗
PubMed2001

Characterization of piezoceramic rectangular parallelepipeds by means of a two-dimensional model.

The characterization of piezoelectric resonators is a field of intense scientific work; moreover, clear and accepted IEEE and IEC Standards have been published, showing the concepts and routes to perform the complete characterization of piezoelectric resonators. All of the accepted procedures define some resonator geometries, each of them related with a set of parameters, that can be obtained following resonance measurements at the corresponding resonance frequencies. The basis of the standards is the existence, for each geometry, of well-defined modes that have been analytically solved. The development of multi-dimensional models of the waves' propagation in piezoceramic materials opens the possibility of characterizing piezoelectric resonators with geometries different from those recommended in the standards. In this paper, a two-dimensional model, which takes into account the mechanical and dielectric losses, has been used to characterize piezoceramics with the shape of a regular parallelepiped. A set of elastic, dielectric, and piezoelectric parameters, which are useful for piezoelectric transducer design, can be obtained. For a given sample, the measured input electrical impedance is used to obtain the parameters by means of a fitting process with the corresponding model output. The results obtained with low and high loss materials show that the parameters found have values similar to those obtained following the procedures and geometries recommended by the standards. This procedure permits the characterization of materials when the manufacturing procedure does not allow the fabrication of the shapes recommended by the standards, making it a useful tool for transducer manufacturers and material scientists.

Journal Article↗
PubMed2000

Theatres of the psyche.

Fragments of the analytic voyage of a forty year old patient, haunted by the idea of her death since infancy when confronted with the anguish that accompanies the discovery of a potentially death dealing illness. In three years of intensive analytic work, her way of functioning psychically changed dramatically (her flight from imaginative life, total disaffectation of her emotional life, psychic deafness regarding her body and its messages...). These discoveries led to my analysand's resuming her psychoanalytic voyage in these words: 'Even if I am destined to die of this cancer, at least I shall have lived'.

Adult↗
PubMed1998

SHO training in anaesthetics. How good is it?

All senior house officer posts in the Yorkshire Deanery have been assessed against five parameters. Posts in anaesthesia were among the best with excellent consultant support, good exposure to clinical practice and well-structured education and training. Anaesthetic posts were almost unique in satisfying the 'New Deal' on junior doctors hours though intensity of work was something of a problem for the on-call senior house officer. Appraisal is a new educational tool which is being used to a greater degree in anaesthetics than in any other specialty. The deficiencies found in anaesthetic posts could be corrected by the universal use of appraisal and solving the recruitment problems that have compromised the delivery of good training in some districts.

Anesthesiology↗
PubMed1994

Nurses' views of infection control: an interview study.

An interview study was conducted among 173 nurses in two hospitals to explore their views concerning infection risks to themselves and patients and to identify any problems they perceived in safely performing infection control precautions during routine activities. Subjects were interested in the topic of infection control and keen to perform optimally, but perceived difficulties related to lack of expert guidance whether or not they had access to an infection control nurse. In one hospital subjects identified shortages of vital equipment (gloves, appropriate handwashing agents), and this was corroborated on a checklist used independently to document the availability of resources. When the opinions of nurses working in intensive care, surgical and medical units were compared, few differences emerged other than those explained by variation in supplies of equipment, except that intensive care unit nurses were more likely to rate their patients and themselves as particularly at risk of infection, Nurses who had been qualified longer, with more than 3 years experience in their specialty, were more conscious of infection risks.

Cross Infection↗
PubMed2006

Long working hours increase the risk of sharp and needlestick injury in nurses: the need for new policy implication.

AIM: This paper reports a study to determine the sharp and needlestick injury incidence in nurses working at a university hospital and the contributing factors. BACKGROUND: Although it is generally felt that working in the healthcare sector is clean and without risk, healthcare staff and especially physicians and nurses who generally work very long hours are actually exposed to various occupational risks. Sharps and needlestick injuries are important problems for healthcare workers as they increase the risk of spread of infection. METHOD: A self-administered questionnaire was completed in October 2005 by 449 of the 516 nurses working at a Turkish hospital (response rate 87.0%). RESULTS: The percentage of nurses experiencing a sharp or needlestick injury during their professional life was 79.7%. The incidence of exposure to sharp or needlestick injury in the last year was 68.4%. The factors increasing the rate of sharp and needlestick injury were: age 24 years and less, <or=4 years of nursing experience, working in surgical or intensive care units and working for more than 8 hours per day (P < 0.05). CONCLUSION: The findings indicate which groups of staff should be targeted for educational programmes. Consideration also needs to be given to the unwanted effects of working long shifts, where tiredness may contribute to the number of needlestick injuries.

Adult↗
PubMedDate not supplied

Keratomycosis due to Scedosporium apiospermum.

Although no overt injury occurred, a corneal abscess without hypopyon developed in a normal, 25-year-old female, living in a suburban area of Madrid, following a period of intensive garden work. Direct examination of the corneal scrapings on one occasion showed septate, branched hyphal elements. When scrapings were cultured on Sabouraud glucose and brain heart infusion agars a pure culture of Scedosporium apiospermum was repeatedly isolated. The patient responded successfully to treatment with miconazole ointment, although a residual immune ring of the cornea remained and final visual acuity was 6/10.

Abscess↗
PubMed2006

The modern office environment desiccates the eyes?

Eye irritation is a common complaint in the office environment. The purpose of this overview is to merge knowledge within indoor air science, ophthalmology, and occupational health to promote understanding eye irritation symptomatology, the cause of which is still partly unknown. High periocular relative humidity appears to protect the pre-corneal tear film against desiccation and sensory irritating pollutants and reduces the development of eye irritation symptoms. This is particularly relevant for intensive computer work, where the pre-corneal tear film is altered resulting in dry spot formation and eye dryness, in addition to enhanced susceptibility towards sensory irritating pollutants. The workplace, thermal conditions, and work schedule (including breaks) should be planned in such a way to help maintain a normal eye blink frequency to minimize alterations of the pre-corneal tear film. The role of relative humidity on eye irritation symptoms should not be underestimated. Multiple short breaks are justified by the beneficial effect on the pre-corneal tear film. In addition, longer breaks in tasks, which require demanding visual work, should be considered. In addition, air temperature as well as certain alkene oxidation products by ozone may worsen eye irritation symptoms, but the latter factor may be smaller at higher relative humidity.

Air Pollutants, Occupational↗
PubMed1996

Burning mouth syndrome: patient management.

Burning mouth syndrome is an underdiagnosed and often poorly managed oral sensory disturbance. This paper discusses the recognition of the condition and suggests clinical approaches to ensure a correct diagnosis and appropriate management. The expansion of the traditional dental role of the dentist is reviewed in the context of overall oral and general health particularly with respect to the syndrome which demands an intensive work-up, open discussions with the patient, and a carefully planned long-term management strategy.

Adult↗
PubMed2001

Mild recurrent neuropathy in CMT1B with a novel nonsense mutation in the extracellular domain of the MPZ gene.

Clinical, electrophysiological, and neuropathological features are reported associated with a novel heterozygote point mutation in the extracellular domain of the MPZ gene, where a transversion at codon 71 in exon 3 leads to a codon stop: Glu71stop (ie GAA-->TAA). A 36 year old woman developed a mild recurrent neuropathy after intensive manual work. The motor nerve conduction velocities were slow without conduction blocks and the nerve biopsy showed signs of demyelination-remyelination, axonal loss, and regular uncompacted myelin lamellae. She inherited the mutation from her father who displayed the same mutation with a normal phenotype. This nonsense mutation may cause a dosage difference of normal P0, and is probably underrepresented in the current mutation data bases. This report further extends the phenotype of MPZ mutations and also emphasises that mild phenotype of CMT1B may be more frequent than has been appreciated.

Adult↗