Biomedical subjects

A M Pheley

Publications and source records attributed to A M Pheley.

26 records · Page 2Linked to original sources

PubMed1993

Carbon dioxide retention and oxygen desaturation during gastrointestinal endoscopy.

BACKGROUND: Pulse oximetry measures arterial oxygen saturation (SpO2), not hypoventilation, which is directly reflected by increases in carbon dioxide tension. METHODS: In the present study, transcutaneous carbon dioxide tension (PtcCO2) and SpO2 were measured during 101 endoscopic procedures selected for long duration or comorbid illnesses, and relationships between hypercapnia and hypoxemia were evaluated. Nasal oxygen was administered only for sustained desaturation (SpO2 < 90%). RESULTS: Mean peak increase in PtcCO2 was significantly higher in patients requiring oxygen for sustained desaturation (16.3 mm Hg; range, 4-52) than in patients breathing room air who had transient or no desaturation (10.2 mm Hg [range, 3-19] and 5.1 mm Hg [range, 0-15]). If nasal oxygen corrected desaturation, even transient recurrence of desaturation indicated worsening CO2 retention, which preceded respiratory arrest in one patient. Independent predictors of hypercapnia were fentanyl and midazolam doses, oxygen requirement, and dementia. CONCLUSIONS: Severe hypoventilation may occur during endoscopy, undetected by clinical observation or pulse oximetry, but only in sedated patients who require supplemental oxygen to maintain SpO2 above 90%. After oxygen supplementation corrects desaturation, recurrence of desaturation implies severe hypoventilation and warrants limitation of further sedation.

Adult↗

PubMed1992

Attitudes toward discussing life-sustaining treatments in extended care facility patients.

OBJECTIVE: To determine nursing home residents' attitudes toward discussing life-sustaining treatment plans with their physicians and the factors associated with these attitudes. DESIGN: Random-sample, interviewer-administered survey. SETTING: Forty-one nursing homes in which some residents were cared for by house-staff physicians of the Hennepin County (Minnesota) Medical Center Extended Care Department. PATIENTS: Random sample of 150 nursing home residents receiving primary care from Extended Care Department physicians, 131 (87%) of whom completed the interview. RESULTS: Older individuals were less likely to have spoken with physicians and family members about treatment plans (p < 0.05), and to have felt that they had more say than necessary in their treatment (P < 0.05). Only 19 (14.5%) residents had formal treatment plan discussions about limiting life-sustaining treatment. Although perceived current health status did not differ between residents with and without treatment plans, those residents who had discussions about advance directives were more likely to report health improvement over the past 6 months (P < 0.05). Residents with formal advance directives were, on average, 8.4 years younger than those without them (P < 0.05). CONCLUSIONS: Younger patients are more likely to have had discussions about life-sustaining treatment and are also more frequently involved in plan development. Preferences for level of involvement should be considered during advance directive planning, and it should be recognized that these preferences may vary with age. Future research should evaluate whether this age relationship is a true age or a cohort effect.

Adult↗

PubMed1990

HIV-antibody testing in a multispecialty group practice.

The authors reviewed the trends in HIV-antibody testing at a multispecialty group practice with more than 280 physicians. Based on a chart review of 243 randomly selected patient records, they judged 38% of the tests ordered to be for low-risk individuals. Forty-five percent of the records documented the patient's informed consent before testing, and only 15% noted that patient education or counseling had been given.

AIDS Serodiagnosis↗

PubMed1986

The relationship between experimental and neuropsychological measures of memory.

The current investigation sought to provide convergent and divergent validational information on both experimental and neuropsychological measures short versus long-term memory. Forty undergraduates (20 male, 20 female) were administered memory assessments from the Halstead-Reitan Neuropsychological Battery, the Luria-Nebraska Neuropsychological Test Battery, and the experimentally developed Paired Associates (Face-Name Association & Distractor tasks). Results indicated that the experimental measures of memory demonstrated a high degree of convergent and divergent validity. Both the Luria-Nebraska Memory Scale and the Halstead-Reitan correlated to long-term measures of memory. The Luria Memory Scale did not significantly correlate to short-term measures of memory. Selected subtests from the Halstead-Reitan correlated to experimentally-derived measures of short-term memory. Implications of this study are discussed and recommendations for future research is discussed.

Journal Article↗

PubMed1985

A validation of two motion sensors in the prediction of child and adult physical activity levels.

The authors sought to assess the reliability and validity of two motion activity sensors in the prediction of observed physical activity levels in adults and children by means of two studies at North Dakota State University in Fargo, North Dakota. In study 1, 50 adults were observed in fall 1984 for one hour of recreational activity while they simultaneously wore two motion sensors: an activity counter (i.e., LSI Moving Activity Monitor (GMM Electronics Inc., Verona, PA)) and an electronic accelerometer (i.e., Caltrac Personal Activity Computer (Hemokinetics, Inc., Vienna, VA)). The results indicated that both the activity counter (r = 0.65) and the accelerometer (r = 0.69) strongly correlated to observed physical activity levels. The two motion sensors also were highly correlated to each other (r = 0.83). A correlation of self-reports of time spent in various types of physical activity to observed physical activity ranged from 0.21 to 0.88 (mean = 0.60). Study 2 evaluated these same two sensors in winter 1984 in 30 preschool children observed in a freeplay situation. Results of this study indicated very modest relationships between observed physical activity levels and accelerometer readings (r = 0.35) and activity counter readings (r = 0.40). The two motion sensors intercorrelated at very modest levels (r = 0.42). The results indicate that while both motion sensors closely corresponded to observed levels of physical activity in adults, neither sensor correlated substantively to observed levels of physical activity in children. Implications for validating and utilizing these sensors in epidemiologic research are discussed.

Age Factors↗

PubMedDate not supplied

Health risks and educational interests in an HMO.

A health survey was randomly administered to 1000 members of a 250,000 member HMO to help develop education programs and establish baseline risks and interests among HMO members. The sample was found to have lower than average risks related to smoking, average risks for weight, and above average risks related to exercise compared to state and national reference standards. The highest level of interest was reported for exercise, followed by stress reduction, weight loss, and smoking cessation. The older age groups were less likely to report an interest in attending fitness programs. The more educated respondents were less likely to attend weight control and stress programs. Based on these results, strategies for increasing involvement in educational programs to reduce health risks are discussed.

Aged↗

PubMedDate not supplied

Lack of correspondence among measures identifying the obese.

Correspondence among eight measures commonly used to identify the obese was investigated in 225 men and 212 women 18-59 years of age. Measures included weight, body mass index (BMI), relative weight, skinfold thicknesses at triceps and subscapular sites, the sum of four skinfolds, percentage body fat (%BF) determined hydrostatically, and total weight of fat. Intercorrelations within various measures of body mass and total fat are high (0.86-0.99), while correlations between the two skinfolds, and among measures of body mass, subcutaneous fatness, and total body fat are much lower (0.57-0.70). The amount of variation in %BF accounted for by correlations with the other individual measures of obesity (other than fat weight) ranges from 32% to 48%. When analyzed categorically, the upper quintiles of the various measures poorly identify the same individuals as the fattest. The median chance-adjusted correspondences were 0.57 and 0.64 for men and women, respectively, with single values as low as 0.40. Analyses of variance (ANOVA) indicate the misclassification occurring among upper quintiles is nonrandom with respect to mean levels of these obesity measures. We find a considerable lack of correspondence among measures commonly used to identify the obese. This lack of correspondence may lead to unanticipated dissimilarity among people variously classified as obese and to bias regarding risks of associated disease or mortality.

Adipose Tissue↗

PubMedDate not supplied

Payroll contracting for smoking cessation: a worksite pilot study.

Twenty-one men and 38 women participated in a worksite smoking cessation/smoking reduction program that combined financial contracts, organized through payroll deduction, and biweekly group treatment sessions. At the end of the program the smoking cessation rate was 51%, validated by expired air carbon monoxide. Six months later the validated cessation rate was 12%. We conclude that payroll incentives may be effective in helping workers quit smoking and offer suggestions for ways to promote better maintenance of this important behavior change.

Adult↗