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PubMed1977

Assessment of the role of surgery for control of lung cancer.

When morphologically stratified, the classification of patients according to surgical stage provides an objective basis for evaluating the results of surgical treatment. In a review of 794 patients according to surgical staging criteria, the data supported concepts regarding differences in the behavior of each cell type as well as major differences in survival between each stage of disease. The overall cumulative five-year survival was 37% for squamous cell carcinoma, 27% for adenocarcinoma, and 27% for undifferentiated large cell carcinoma. Fewer than 1% of patients with undifferentiated small cell carcinoma survived. Survival for patients with surgical Stage I disease was 53%, for Stage II 29%, and for Stage III 16%. The results of surgical treatment for patients with limited disease extent are much better than is generally realized. Fifty to 60% of such patients in this series survived five years. Survival studies by surgical stage permit resonable estimates of the presence of occult metastatic disease and supply insights necessary to the design and appropriate selection of adjunctive therapeutic programs.

Adenocarcinoma↗
PubMed2000

Posterior shoulder instability.

Understanding the anatomic restraints to posterior shoulder instability and the resulting pathophysiology helps the treating physician make a correct diagnosis and formulate an appropriate treatment plan. A nonoperative program directed at reducing pain and increasing stability through comprehensive shoulder strengthening methods has generally been successful in treating recurrent posterior shoulder subluxation. Surgical options for treatment are reserved for those patients who fail to recognize improvement after six months of therapy and have no evidence of a psychological disturbance as the cause of their posterior instability.

Exercise Therapy↗
PubMed1998

Behavioral modification for institutionalized individuals with urinary incontinence.

OBJECTIVES: To review the evaluation of urinary incontinence (UI) in institutionalized individuals and to discuss the use of behavioral modification in this population. METHODS: The functional characteristics and patterns of incontinence typical of the institutionalized population are described to explain the rationale for the use of behavioral therapies. RESULTS: Both mental and physical status must be evaluated when considering behavioral therapies for UI in institutionalized patients. Institutionalized individuals often have significant functional impairment that prevents the use of behavioral therapies requiring extensive patient participation. Assessments of bladder function and the severity of UI are also important when planning therapy. In appropriate candidates, a prompted voiding program can be expected to reduce the severity of incontinence and improve the quality of life, even though normal bladder control is rarely achieved. Standardized protocols for the implementation of a prompted voiding program have been developed. CONCLUSIONS: Few treatment options for UI are feasible for use in institutionalized individuals. However, prompted voiding can reduce the severity of UI in most of these patients and will thereby improve the quality of life.

Behavior Therapy↗
PubMed2001

Ovarian response, embryo recovery and results of embryo transfer in a Hungarian native pig breed.

The objective of the study was to use embryo transfer (ET) for propagation of the Swallow Belly Mangalica population. Mangalica is a native Hungarian pig breed adapted to extreme climate and housing conditions and distinguished for excellent meat and fat quality. However, due to their weak reproductive characteristics and relatively high fat proportion, Mangalica pigs have been replaced by modern breeds. Now, there is an increased interest again to safeguard the properties of this breed. We conducted two experiments. First, we used a total of 18 puberal Mangalica gilts to determine an optimal superovulatory treatment. Following estrus synchronization with Regumate, we injected gilts with either 750, 1000 or 1250 IU PMSG, followed by 750 IU hCG 80 h later. We scanned ovaries endoscopically 3 days after hCG administration. The application of 1000 and 1250 IU PMSG resulted in a higher rate of ovulation compared to 750 IU (24.2 +/- 3.6 and 21.0 +/- 2.3 vs. 13.7 +/- 2.7 P<0.05). The number of follicular cysts increased after administration of 1250 IU PMSG compared to 750 and 1000 IU (2.0 +/- 1.3 vs. 0.3 +/- 0.7 and 0.2 +/- 0.3, P<0.05). Thus, we chose 1000 IU PMSG for further stimulation of Mangalica gilts. In the second experiment, we induced superovulation in 10 Mangalica donor gilts by 1000 IU PMSG and 750 IU hCG. Gilts were fixed-time inseminated, and then five days later embryo collection was carried out surgically (n=6) or endoscopically (n=4). Out of the 187 ova recovered, 92.5% were at the morula/blastocyst stage. The embryo recovery rate was higher following surgical flushing than following endoscopy (91.5 +/- 4.4% vs. 71.4 +/- 12.7%, P<0.05). Altogether 143 embryos were transferred surgically or endoscopically into 8 Landrace recipients. Surgical and endoscopic transfer of Mangalica embryos into Landrace gilts resulted in pregnancies in 3 and 2 gilts, respectively; thus the overall farrowing rate was 62.5%. The birth of 59 Mangalica piglets from 5 embryo recipients equals an average litter size of 11.8 +/- 1.3, which is two times larger than usual in this breed. Therefore, we concluded that an appropriate inter-breed ET program is a suitable tool to propagate the endangered Mangalica breed.

Animals↗
PubMed1999

Certification in infection control and epidemiology-a celebration of 15 years!

Certification in infection control has been available since 1983. In this, the 15th anniversary of the Certified in Infection Control examination, it seems appropriate to examine how the program was developed, how it has evolved, and future opportunities for Certification in Infection Control and Epidemiology. This article was written to provide a brief history and an update on the current status of the Certified in Infection Control program.

Certification↗
PubMed2003

Introduction of a HIV vaccine in developing countries: social and cultural dimensions.

Using insights from studies on social and cultural aspects of immunization in Africa and Asia the paper discusses the introduction of a HIV vaccine from three perspectives. Firstly, it shows how at the side of public health programs local differences will impact on the introduction of a new vaccine. Secondly, it elaborates how at the side of the users of vaccinations acceptance, non-acceptance and demand of and for a new vaccine are related to local vaccination cultures, images of the HIV/AIDS epidemic, and perceptions of vaccine potency and efficacy. Thirdly, it points out socio-cultural aspects of the introductory process. Tailoring health education and social marketing to local conditions and local interpretations of globally provided information will be decisive for a successful introduction. Strong public health programs with highly motivated and appropriately supported staff are another necessary condition.

AIDS Vaccines↗
PubMed2003

In search of a healing place: Aboriginal women in Vancouver's Downtown Eastside.

Research on general health service delivery in urban areas of Canada shows that Aboriginal people face formidable barriers in accessing culturally appropriate and timely care. Over the past decade, Urban Aboriginal Health Centres (UAHCs) have emerged to address the unmet health concerns of Aboriginal people living in metropolitan areas of the country. The purpose of this research was to address the gap in social science literature on how the health care concerns of Aboriginal women are being met by UAHCs. The research aimed to give voice to Aboriginal women by asking them whether the appropriate professional services and educational programs they need to address their health care needs were being provided in the inner city. A case-study approach was used whereby three separate focus groups were conducted with Aboriginal women who were clients of the Vancouver Native Health Society (VNHS), its sister organization, Sheway, or residents of Vancouver's Downtown Eastside (DTES). In addition, twenty-five semi-structured interviews were conducted with VNHS staff, health providers, government representatives, and community leaders in health care (total n=61). The findings indicate that despite efforts from various quarters to articulate the health and social concerns of the country's marginalized populations, such has not been the case for Aboriginal women living in one of Canada's most prosperous cities. Many Aboriginal women expressed a strong desire for a Healing Place, based on a model of care where their health concerns are addressed in an integrated manner, where they are respected and given the opportunity to shape and influence decision-making about services that impact their own healing.

American Indian or Alaska Native↗
PubMed1999

Nutritional requirements to increase lean mass.

If a physician determines that an athlete has the potential to increase lean body mass, the following components are necessary for success: appropriate progressive resistance-training program. Adequate rest and sleep. Adequate energy intake. Five to nine eating occasions a day. Increased amount of food if possible. High energy supplements. Adequate protein intake. [table: see text]

Body Composition↗
PubMed2000

A lifetime of fitness. Exercise in the perimenopausal and postmenopausal woman.

The peri- and postmenopausal woman experiences physiologic changes of aging that include alterations in hormone levels. Research has shown that the perimenopausal and postmenopausal woman can benefit significantly from exercise, whether endurance or strength training. Exercise can improve the quality of life and attenuate some of the physiologic changes associated with aging. Additionally, exercise can ameliorate the decline in fitness and bone, prevent chronic disease, and promote functional independence. Women who exercise regularly throughout life are physiologically 20 to 30 years younger than their sedentary counterparts. Fitness is a lifetime endeavor that has many positive benefits. Weightbearing activities are especially important as bone loss increases in the perimenopausal phase of life. Women should perform aerobic exercise 3 to 7 days per week for 15 to 60 minutes at 65% to 70% HRreserve. Strengthening exercises should be done 2 to 3 days per week at 40% to 80% 1RM with appropriately selected exercises. An exercise program should be functional and enjoyable. There is no better motivation to exercise than having a partner to work out with and keep the motivation alive. Most important, age itself is not a deterrent to exercise.

Body Composition↗
PubMed1998

Invisible residents: the chronically mentally ill elderly in nursing homes.

This article presents results from a retrospective study of psychological assessments of elderly persons with chronic mental illness residing in nursing homes. All residents (N = 570) received this assessment as part of federally mandated screening for mentally ill persons residing in long-term care. The process, the Preadmission Screening and Resident Review, was mandated by the Omnibus Budget Reconciliation Act (OBRA 87). These assessments were the first stage in a process to determine if the nursing home was the most appropriate placement for each resident. If nursing home care was deemed appropriate, then a psychological treatment program was to be established within the nursing home setting. The sample ranged in age from 50 to 104 (mean of 70). The majority had a diagnosis of schizophrenia and a history of psychiatric hospitalization occurring early in their life. The assessments did not include any quantifiable data on activities of daily living, cognitive functioning, or level of psychiatric impairment. Therefore, the researchers coded the narrative data so that it could be interpreted. The majority functioned within the none-to-mild range of cognitive impairment, and very few were completely dependent in the need for physical care. The most recorded symptom was social withdrawal. Neuroleptic medications were administered to 64% of elderly persons with chronic mental illness. Importantly, there was no relationship between demographic or clinical information and treatment recommendations. Implications of these findings for psychiatric nurses are discussed.

Activities of Daily Living↗
PubMedDate not supplied

Twenty-four-hour blood pressure monitoring in normoalbuminuric normotensive type 1 diabetic women during pregnancy.

UNLABELLED: We monitored blood pressure (BP) for a 24-h period in type 1 diabetic women at each trimester of pregnancy (10-13, 20-22, and 30-33 weeks of gestation) to identify early alterations of BP profile in pregnancies complicated by hypertension. PATIENTS AND METHODS: We prospectively studied 71 type 1 diabetic pregnant women and 48 nondiabetic pregnant women (homogeneous by age and pre-pregnancy BMI) consecutively recruited at 10+/-2 weeks of pregnancy in the space of 2 years (1999-2000). They were all normotensive (<130/80 mm Hg) and normoalbuminuric (AER<20 microg/min) at entry to the study. STATISTICS: Analysis of variance (ANOVA) and simple regression and chi(2) were applied as appropriate by an Apple software program (Stat View). RESULTS: In diabetic women, we recorded higher levels of diastolic BP (even if within a normal range) at each time point; diabetic vs. nondiabetic women: first trim daytime diastolic BP: 71.35+/-8.75 vs. 67.7+/-9.7, P=.01; second trim nighttime diastolic BP: 62.15+/-6.45 vs. 58.05+/-6.7, P=.05; third trim nighttime diastolic BP: 66.03+/-8.72 vs. 60.7+/-6.5, P=.01. Among diabetics, those who later developed pregnancy-induced hypertension (36.6%) showed significantly higher values of BP at the first and third trimester compared to those who remained normotensive. In the two groups, there were no differences in age and pre-pregnancy BMI by contrast of diabetes duration (hypertensive vs. normotensive, 19.18+/-7.3 vs. 14.35+/-9.1 years, P=.03) and age of diagnosis (hypertensive vs. normotensive, 9.6+/-5.5 vs. 14.7+/-8.6 years, P=.01). Positive correlation was found between fasting blood glucose and diastolic BP at each trimester of pregnancy.

Adult↗
PubMed2002

Return to work after foot and ankle injury.

A surgeon faces important issues when returning a patient to the workplace, including workers' compensation issues and the need for physician guidance. These patients deserve appropriate diagnosis and treatment protocols, and the other members of the workers compensation treatment team can help maximize the effects of careful guidance by a physician. The speediest possible return to the workplace is usually best for all concerned, the injured worker, the employer and the physician. The treatment team within the workers' compensation system assists in the facilitation and coordination of the medical care and assists in bringing the patient back to work. The team includes the nurse case manager, the insurer, and physical and occupational therapists. Appropriate use of work hardening programs or functional capacity evaluations can be valuable in the return-to-work effort. Physicians who make use of these resources may find it easier to guide this process efficiently to achieve the desired outcome of return to work of the injured worker.

Accidents, Occupational↗
PubMed2005

A prelimary study of a health-promoting lifestyle among South Asian women in Taiwan.

The purpose of this study was to determine and understand the predicting factors of a health-promoting lifestyle (HPL) in Southeast Asian women in Taiwan. One hundred and five Southeast Asian women in Tainan were recruited. Face-to-face interviews with structured questionnaires were used for data collection. The findings showed that, among the six dimensions of HPL, subjects scored highest in self-actualization and lowest in health responsibility. Subjects who could read and write Chinese had a more positive HPL; stepwise regression analysis revealed that the ability to read Chinese could explain 26.2% of the total variance of HPL in Southeast Asian women. The results of this study can help health care professionals understand the HPL and to design appropriate health-promoting educational programs to improve the well-being and overall quality of life of Southeast Asian women in Taiwan.

Adult↗
PubMedDate not supplied

Teaching qualitative research through participatory coursework and mentorship.

Many doctoral programs in nursing now offer at least one course in qualitative research. Yet it remains a challenge to adequately prepare new qualitative researchers due to lack of faculty expertise and mentorship, student unfamiliarity with qualitative research when entering the doctoral program, and uncertainty as to appropriate teaching methods. The authors describe how they addressed these issues historically and in their current two-course qualitative research sequence. Accompanying reports of four studies conducted by students who completed the two-course sequence during academic year 1996 to 1997 provide evidence of the viability of the authors' approach and serve as the basis for recommendations to others who use a similar strategy for teaching qualitative research.

Curriculum↗
PubMed1983

C.T. aided stereotaxy for depth electrode implantation and biopsy.

We describe a computer program which facilitates the analysis of a series of C.T. scans made while a stereotaxic frame is fixed to the patient. The program has 2 modes of operation: a) The operator may select a region and determine the three-dimensional frame coordinate. b) The operator may select a set of frame coordinates and have the computer program display these at the appropriate sites on the C.T. scans. It these sites are the positions of depth electrodes, then a recording of the epileptic spike activity may be displayed at the appropriate sites on the scans.

Adult↗
PubMed2007

Switching surface chemistry with supramolecular machines.

Tethered supramolecular machines represent a new class of active self-assembled monolayers in which molecular configurations can be reversibly programmed using electrochemical stimuli. We are using these machines to address the chemistry of substrate surfaces for integrated microfluidic systems. Interactions between the tethered tetracationic cyclophane host cyclobis(paraquat-p-phenylene) and dissolved pi-electron-rich guest molecules, such as tetrathiafulvalene, have been reversibly switched by oxidative electrochemistry. The results demonstrate that surface-bound supramolecular machines can be programmed to adsorb or release appropriately designed solution species for manipulating surface chemistry.

Electrochemistry↗
PubMed2006

One-pot synthesis of macrocycles by a tandem three-component reaction and intramolecular [3+2] cycloaddition.

By combining three appropriately designed simple substrates, a programmed sequence involving an alpha-isocyano acetamide-based three-component reaction followed by a copper-catalyzed intramolecular [3+2] cycloaddition of alkyne and azide took place to afford complex macrocycles in moderate to good yields. One macrocycle and two heterocycles were produced with concurrent formation of five chemical bonds in this operationally simple process.

Macrocyclic Compounds↗
PubMed2000

Monitoring of isoflurane and desflurane breakdown: interfering gases and infrared detection.

OBJECTIVE: The reaction of isoflurane, enflurane or desflurane with dried CO2 absorbents produces carbon monixide (CO), a highly toxic gas which cannot be detected by gas monitors typically available in the operating room. Trifluoromethane (CHF3) is produced along with CO when this reaction occurs with isoflurane and desflurane, and can be detected by gas monitors. This study will determine the ability of a modified SAM module (Smart Anesthesia Multigas Module, GE/Marquette Medical Systems, Milwaukee, WI) to identify the presence of CHF3, and provide a clinically useful indirect warning of CO production. METHODS: Isoflurane (1.5%) and desflurane (7.5%) were reacted under clinical conditions with desiccated absorbents resulting in CO production. CO and CHF3 concentrations were measured using gas chromatography. The CHF3 concentrations measured by a modified SAM monitor were compared with the measurements obtained by gas chromatography. Alarm limits set on the SAM monitor were used to warn of the presence of CHF3. RESULTS: A concentration of 0.25% CHF3, as measured by the SAM monitor, corresponds to an average CO concentration of 780 ppm for isoflurane and 1700 ppm for desflurane. Lowering the threshold to 0.05% CHF3 would result in an average CO concentration of 155 ppm CO for isoflurane and 345 ppm CO for desflurane. CONCLUSIONS: We have shown that the SAM module is capable of measuring CHF3 due to anesthetic breakdown. With appropriate changes in the display programming and reference cell spectra the monitor would be able to provide an early warning of CO exposure, although the amount of CO would not be reported.

Anesthesia, General↗