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Biomedical subjects

B J Leonard

Publications and source records attributed to B J Leonard.

At least 19 recordsLinked to original sources
PubMed2001

Quality nursing care celebrates diversity.

At the beginning of the 21st century, the familiar biomedical health care "culture" must accommodate not only persons from diverse cultures, but also diverse systems of care. For perhaps the first time in over a century, biomedicine must accommodate others rather than require them to assimilate into its "culture." This fundamental shift requires nurses to move quickly to develop cultural competency as individuals and to provide leadership for this system-wide change. Such competence is important when using complementary and alternative modalities. This article addresses America s experience with diversity and its legacy in today s health indicators; it explores cultural competency and its achievement at the individual and system levels; and it discusses the use of complementary and alternative treatments that are a part of this health care "revolution." Nurses are challenged to shape this reform as did the founder of modern nursing 150 years ago.

Clinical Competence↗
PubMed2000

Activation and active site occupation alter conformation in the region of the first epidermal growth factor-like domain of human factor VII.

The first epidermal growth factor-like domain (EGF-1) of factor VII (FVII) provides the region of greatest contact during the interaction of FVIIa with tissue factor. To understand this interaction better, the conformation-sensitive FVII EGF-1-specific monoclonal antibody (mAb) 231-7 was used to investigate the conformational effects occurring in this region upon both FVII activation and active site occupation. The binding affinity of mAb 231-7 was approximately 3-fold greater for the zymogen state than for the active state; a result affected by the presence of both calcium and the adjacent Gla domain. Once activated, active site inhibition of FVIIa with a variety of chloromethyl ketone inhibitors resulted in a 10-fold range of affinities of FVIIai molecules to mAb 231-7. Gla domain removal eliminated this variation in affinity, suggesting the involvement of a Gla/EGF-1 interaction in this conformational effect. In addition, the binding of mAb 231-7 to FVIIa EGF-1 stimulated the amidolytic activity of free FVIIa. Taken together, these results imply an allosteric interaction between the FVIIa active site and the EGF-1 domain that is sensitive to variation in active site occupant structure. Thus, these present studies indicate that the conformational change associated with FVII activation and active site occupation involves the EGF-1 domain and suggest potential functional consequences of these changes.

Allosteric Site↗
PubMed2000

Awareness: the heart of cultural competence.

Cultural competency in critical care is providing care to patients and their families that is compatible with their values and the traditions of their faiths. This requires awareness of one's own values and those of the healthcare system. The nurse must also become aware of the cultural and spiritual values of patients and families. Although knowledge of many cultures is impossible, willingness to learn about, respect, and work with persons from different backgrounds is critical to providing culturally competent care. This article discusses elements essential for increasing cultural competency.

Attitude of Health Personnel↗
PubMed1998

Factor VII deficiency caused by a structural variant N57D of the first epidermal growth factor domain.

We have previously described a kindred with factor VII (FVII) deficiency whose members exhibited reduced procoagulant activity relative to FVII antigen concentration. In this report, the molecular genetic basis of the FVII defect has been determined to be a heterozygous substitution of Asp for Asn at position 57 in the first epidermal growth factor (EGF) domain. Recombinant FVII (N57D) cDNA was created by site-directed mutagenesis and transiently expressed in human 293 cells. The transfected cells synthesized an immunoprecipitable protein with an apparent molecular weight of 50 kD. Quantitation of expression by FVII enzyme-linked immunosorbent assay indicated that mutant protein yields were consistently low, typically 10% to 30% of wild-type FVII. FVII (N57D) protein did not accumulate intracellularly, and Northern blot analysis indicated equivalent FVII mRNA levels in 293 cells expressing either wild-type FVII or FVII (N57D). Secreted FVII (N57D) protein did not bind tissue factor, exhibited no procoagulant activity, and failed to bind a conformation-dependent monoclonal antibody specific for the first EGF domain of FVII. Molecular modeling of the first EGF domain of FVII predicted that the N57D amino acid substitution would disrupt tertiary bonding structure. We conclude that the N57D mutation affects folding of the first EGF domain of FVII resulting in decreased cellular secretion of a mutant FVII molecule, which is unable to bind tissue factor and is therefore biologically inactive.

Animals↗
PubMed1998

Self-management development in children and adolescents with diabetes: the role of maternal self-efficacy and conflict.

The overall purpose of this study was to investigate maternal self-efficacy and its relationship to maternal perception of the child's self-management of diabetes. The influence of conflict between mother and child was also examined. One hundred and four mothers of children, ages 8 to 17 years, who were attending summer diabetes camp, were asked to rate their own and their child's abilities to manage the child's diabetes. Overall, the mothers expressed a high degree of self-efficacy in managing their child's diabetes and perceived their children as average or above in managing their own diabetes when compared with agemates with diabetes. Furthermore, mother's level of self-efficacy was significantly positively related to their perceptions of their child's self-management. In addition, almost one third (30%) of the mothers reported experiencing interpersonal conflict regarding how much responsibility the child should assume in managing their own diabetes. Mothers who rated their child's level of independence as low were three times more likely to report experiencing conflict. In the vast majority of cases, the child was the primary source of conflict. When hierarchical logistic regression was used to multivariately model children's independence, conflict with the child remained a significant predictor, above and beyond background, demographic, and important conceptual variables, including self-efficacy.

Adaptation, Psychological↗
PubMed1994

Identifying potential dropouts through school health records.

This study of the records of 255 ninth grade, inner-city Midwestern high school students shows that students who drop out of school are several times as likely to have incomplete health information in the school health record as students who stay in school. A cluster of five variables--vision screening, scoliosis screening, visits to the health office, age and attendance--were found to provide 85% or better accuracy in estimating actual drop-out rates. Missing or incomplete data in combination with attendance data thus become powerful predictors of potential dropouts.

Adolescent↗
PubMed1994

Caring for medically fragile children at home: the parent-professional relationship.

Forty-eight mothers and fathers caring for a medically fragile child at home completed questionnaires and were interviewed about the impact of this caregiving on their family and about their relationship with home care professionals. Factors contributing to a positive parent-professional relationship were professional competence, genuine caring for the child, and respectful, supportive collaboration with the family. More hours of care provided by home health aides increased mothers' strain with the professional caregivers; more hours of care from nurses increased fathers' strain. Family cohesion, family organization, and support from the community reduced the amount of strain parents reported having with home care providers. Implications for training providers and reducing the negative impact of home care are discussed.

Adolescent↗
PubMed1993

Caregivers of children with disabilities: a comparison of those managing "OK" and those needing more help.

A survey was mailed to caregivers of children with disabilities to ascertain how they were managing caregiving. Caregivers reporting they were managing "OK" were compared to those who reported they needed more help or could not manage much longer ("not OK"). Results showed the not OK group of caregivers had children who were more severely impaired and functionally dependent. Their mothers were in poorer physical and mental health, had greater demands placed on their time and finances, and received less emotional support from friends and family. Special programs provided some assistance but not enough to meet their needs.

Adolescent↗
PubMed1993

Parental distress: caring for medically fragile children at home.

Home care (rather than hospital care) for a diverse group of medically fragile children has expanded in the last decade without an adequate understanding of its impact on families. In this report, the psychological distress of parents was measured using family data and a standardized psychological distress instrument. Of 57 families studied, 59% of the mothers and 67% of the fathers reported significant levels of distress symptoms. Regressions analysis suggest that factors associated with increased family responsibility contribute to parents' distress. The type and amount of professional support also affect parental distress.

Adolescent↗
PubMed1992

Children's ice hockey injuries.

OBJECTIVE: To determine the rate, type, and severity of injuries to child hockey players as well as assessing coaches', parents', and players' attitudes and knowledge of hockey. DESIGN: A prospective observation of a population's injuries using injury-reporting forms and surveys. SETTING: A community-organized hockey program in Minnesota. PARTICIPANTS: One hundred fifty boys, aged 9 through 15 years, who played ice hockey during the 1990-1991 winter season. MEASUREMENTS AND MAIN RESULTS: Injuries were reported by multiple observers, including coaches, managers, and trained independent observers at the time an injury occurred; coaches, parents, and players were surveyed regarding hockey injuries, knowledge, and attitudes. One in three players experienced an injury during the season. The most common injuries were contusions. Six of 100 players experienced injuries severe enough to require cessation of physical activities for 8 to 25 days or longer. Weight differences of 53 kg and height differences of 55 cm were reported between Bantam-aged players (13 through 15 years), and body contact, including legal checks, accounted for 86% of injuries during games. Illegal checks and violations were associated with 66% of injuries during games, yet only four penalties (14%) were assessed. In addition, one in three games in which an injury resulted was described as hostile and 15% of the injuries were considered intentional. CONCLUSIONS: Eliminating violence and body checking for prepubertal boys while emphasizing rule enforcement and good sportsmanship are recommended.

Adolescent↗
PubMed1992

Maternal time and the care of disabled children.

Caring for disabled children has become increasingly the responsibility of parents, even when the medical care is complex. To assess the time commitment required, 133 mothers of disabled children were asked to estimate by specific task categories the extra time required to care for the children. Total average daily care time was reported at 12 hours and 6 minutes, with 6 hours and 30 minutes consumed in "vigilant" tasks (i.e., watching a child who cannot be left alone and/or providing emotional support). Multiple regression analysis showed an increase in total caregiving hours associated with a younger child who was more physically and mentally impaired, and who required more medical treatments. The amount of time required by parents to care for their chronically ill children of necessity results in lost opportunities. Because this burden is experienced primarily by women and because professional nurses could alleviate some of the burden, this issue deserves further study.

Adaptation, Psychological↗
PubMed1992

Home care for medically fragile children: impact on family health and well-being.

The health status of 48 families providing home care for their medically fragile children was studied. Mothers, as the primary caregivers, experienced a greater decline in their physical health than did fathers or siblings. When the financial burden of providing care was greater and when the relationship with care providers was more strained, families had more physical illness symptoms. Who provided home care services for the medically fragile child influenced the psychosocial impact on the family. Care provided by home health aides was associated with greater negative impact, whereas care from professional nurses reduced the negative impact. The trend toward home care for medically fragile children has been accelerating; this study points to the importance of studying the impact on the family of this kind of care. Policy implications regarding the amount and quality of services and payment for them are discussed.

Adaptation, Psychological↗
PubMed1992

Maternal perception of first-born infants: a controlled comparative study of mothers of premature and full-term infants.

Mothers of premature infants monitored at home for apnea and mothers of full-term infants had significantly more positive perceptions of their infants than mothers of premature infants not monitored. Using the Brief Symptom Inventory 2 weeks after the infants went home from the hospital, the mothers of infants not monitored reported significantly more psychological symptoms than the other two groups. Maternal perceptions of their infants had not changed when interviewed 6 months later. Implications for nursing practice are discussed.

Adult↗
PubMed1991

Determinants of home care nursing hours for technology-assisted children.

In the 1980s home care, in contrast to hospital care, was reported substantially to reduce costs for third-party payers who provided funding for technology-assisted children. Savings were realized primarily because parents substituted for nurses, eliminating or reducing those costs. Third-party payers' savings thus were directly related to the number of hours parents assumed care. Because home care relies on parents doing some of the work of nurses, decisions regarding nursing hours must consider family factors in addition to medical factors. We evaluated the number of nursing hours 31 Minnesota families with technology-assisted children received, as well as the factors that determined the allotment of nursing hours. Most families (96.8%) received some hours of nursing hours. Most families (96.8%) received some hours of professional nursing care per day, and 16.1% received 24-hour care. Multiple regression, however, showed that family factors, rather than the child's medical condition, influenced the number of hours, with married, lower-income families with a younger child receiving the fewest. Further discussion and study are recommended to understand more fully the impact family factors have on the allotment of nursing hours and home care costs.

Adolescent↗
PubMed1991

Self-concept of children and adolescents with cleft lip and/or palate.

The self-concept of 105 children (8 to 11 years) and adolescents (12 to 18 years) with cleft lip and/or palate (CLP) was studied using the Piers-Harris Children's Self-Concept Scale and selected demographic and medical variables. Results indicated that most (98%) of children had average or above average self-concept scores. Further analysis, however, demonstrated an interaction between age and gender: adolescent girls experienced a more negative self-concept in comparison to younger girls and adolescent boys experienced a more positive self-concept in comparison to younger boys. In addition, popularity cluster scores for all children were below the mean for the normed population. Because children with CLP have additional difficulties (i.e., facial disfigurement, speech and language deficits, multiple surgeries), professionals should intercede to prevent or interrupt negative psychosocial outcomes, particularly for adolescent girls.

Adolescent↗
PubMed1991

Siblings of chronically ill children: a question of vulnerability versus resilience.

The study of siblings of chronically ill brothers or sisters would benefit from a change in perspective. Research in the last decade still framed studies from the perspective of vulnerability rather than resilience. Having benefited from these studies, the study questions need to be reframed. Because childhood chronicity is a given, identifying risk factors for both able-bodied brothers and sisters as well as disabled children can reduce negative outcomes for these children and their parents. Many children are living successfully with disabled siblings, and their success should be the focus of current research so that appropriate interventions can be initiated.

Adaptation, Psychological↗
PubMed1991

The use of two-dimensional echocardiography during catheter ablation of the atrioventricular node.

Atrioventricular nodal catheter ablation has proved an effective option in patients with drug-refractory, uncontrolled, supraventricular tachyarrhythmias; however, many complications in the immediate post ablative period relate to direct myocardial damage due to the electrical current generated by the catheter. The authors used two-dimensional echocardiography in a 57-year-old female patient with recurrent uncontrolled rapid ventricular rates despite multiple antiarrhythmic medications, in an attempt to identify the sequence of events responsible for complications of the ablation procedure. The echocardiographic images showed evidence of an explosion: microbubbles outlining an expanding force were seen which, if contained in a confined space such as the coronary sinus, might explain previously observed mechanical damage. Two-dimensional echocardiography may be useful for continual monitoring of catheter position during ablation.

Arrhythmias, Cardiac↗