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Biomedical subjects

B McLeod

Publications and source records attributed to B McLeod.

At least 19 recordsLinked to original sources
PubMed2001

An investigation of the applicability of the inventory, satisfaction with amplification in daily life, at 2 weeks post hearing aid fitting.

OBJECTIVE: To investigate the applicability of the self-report inventory, Satisfaction with Amplification in Daily Life (SADL), at 2 wk postfitting. DESIGN: The SADL was completed by two groups of hearing aid users, one fitted 2 wk before completion, the other at least 1 yr before. All SADLs were completed as a paper and pencil exercise, without involvement of an audiologist or other clinic staff. All the aid users were Government funded, all were fitted with the same model hearing aid, all were over the age of 60 yr, and all were fitted and counselled by the same two audiologists. Comparisons were made of the two groups' scores on each subscale and Global score, as well as on scores for each individual question. RESULTS: All scores for subscales, Global score, and individual questions were higher at 2 wk postfitting than at 1 yr. Significant differences were found for subscales Positive Effect (p < 0.05), Service and Cost (p < 0.025), Negative Features (p < 0.001), as well as for the Global score (p < 0.001). The only subscale not resulting in a significant difference was Personal Image (p > 0.10). It was noted that Negative Features, such as background interference, acoustic feedback, and problems with telephone use, apparently take longer to be observed than Positive Effects such as improved communication and good sound quality. By contrast with some other reported studies, these results all display a reduction in self-reported outcome, rather than stability, or even improvement, over time. Among other possibilities, this finding may suggest the SADL measures something different to that measured by other inventories. CONCLUSIONS: The results of this investigation suggest that, if the aim is to predict long-term satisfaction with aid fitting, 2 wk postfitting is too early for meaningful application of the SADL as an outcome measure. It is possible that an earlier stability in SADL scores might be obtained by inclusion of additional questions aimed at earlier detection of negative features. Such inclusions may detract from one of the SADL's advantages, namely its brevity. It also is suggested that the long-term value of self-report methods will depend on development of rigorous and scientifically acceptable administration procedures, including appropriate times for application.

Aged↗
PubMed2001

Linking nursing pain assessment, decision-making and documentation.

A clinical nurse specialist's (CNS) experience in the development and implementation of a pain assessment and treatment flowsheet (PATF) to enhance the nursing assessment, decision-making, and documentation of pain on a palliative care unit in a community hospital is described in this article. Members of the palliative care interdisciplinary team use the PATF for clinical decision-making in the day-to-day management of patients' pain. The PATF is undergoing revision and re-implementation to promote the utilization of the tool beyond the specialty of palliative care and into the general patient population.

Decision Making↗
PubMed2000

Defective deletion mutant amplification.

Defective deletion mutants can be replicated in superinfected cells by parasitism of the intact virus' replication machinery, and through replication with the host cell. We show by analysis of a mathematical model that dynamic stability of superinfected cell growth is crucial in determining the frequency of deletion mutant infected cells, i.e. there is a critical infectivity threshold rho(sc)below which the density of proliferative virus is significantly reduced by the presence of defective deletion mutants. Above rho(sc), proliferative virus principally occurs as superinfected cells (wild type with defective deletion mutant). The threshold rho(sc), and the interference effects of the deletion mutant, increase with deletion mutant parasitism of the wild-type replication machinery in superinfected cells. The interaction of virally infected cells with host homeostasis determines whether immune escape by deletion mutant infected cells is necessary for the interference window to exist. Only when the deletion mutant has a detrimental effect on infected host cell replication did we observe periodic behaviour.

Animals↗
PubMed1998

Audit of the frequency and clinical response to excessive oral anticoagulation in an out-patient population.

A retrospective review of over-anticoagulated patients with critical international normalized ratios (INRs) was undertaken in a large outpatient laboratory. In the six-month study period, 85 prothrombin times (PTs) were identified with an INR of > or = 6.0, an overall incidence of elevated PTs of 0.2% or two per 1,000 INR tests. Complete follow-up data was available on 65 patients. When compared to an age- and gender-matched control group without INR > or = 6.0, high-INR patients were significantly more likely to manifest the presence of alcoholism or liver disease, to have been anticoagulated for less than six months, to have experienced more frequent warfarin dosage changes, and to have had the addition of a medication known to interact with warfarin. In the high-INR group, a likely cause for the specific critical INR was identified in 44 patients (68%). Drug interactions followed by compliance problems were the most common factors identified. The 13 patients (20%) who received vitamin K therapy experienced no difference in the clinical outcome compared with those managed conservatively. Conservative management of critically high INR values appeared to be as efficacious as intervention with vitamin K therapy.

Administration, Oral↗
PubMed1997

Prothrombin time determination. The lack of need for a discard tube and 24-hour stability.

The National Committee for Clinical Laboratory Standards (NCCLS) recommends that all coagulation studies be done on a specimen from the tube drawn second or later. For patients receiving long-term anticoagulant therapy, this may require that the first tube of blood drawn be discarded for each prothrombin evaluation. In a prospective study we compared the prothrombin times (PTs) as international normalized ratios (INRs) from a series of three tubes obtained from 241 patients receiving consistent dosages of oral anticoagulant therapy to determine the need for discarding the first tube drawn, as well as the stability of PT determinations over a 24-hour period. Tube one was treated as the discard tube. Tubes one and two were analyzed within the laboratory's standard 4-hour time frame, while tube three was kept stoppered at room temperature, centrifuged a half hour before PT determination, and analyzed after a 24-hour delay. Comparisons of the INRs were made in four ranges comprising 1.2 to 2.0, 2.1 to 3.5, 3.6 to 5.9, and 6.0 or more. Most INR comparisons were less than the 10% maximum variance listed as acceptable by the NCCLS. A comparison of INR results between tube two and tube one showed a statistically significant difference only for the INR range of 6.0 or more. The comparison of the 24-hour specimen with tube one showed statistically significant differences in paired t testing for the first three INR cohorts. However, the 95% confidence intervals demonstrated that these mean differences were probably too small to be clinically significant. For the fourth cohort (INR > or = 6.0) the mean difference was not significantly different on paired t testing, but the 95% confidence interval was larger at -0.07 to 0.839. In this sample of outpatients receiving consistent dosages of oral anticoagulant therapy the use of a discard tube seemed unnecessary, and the 24-hour stability of PT determinations was documented.

Adult↗
PubMed1997

Analgesic and respiratory effect of nalbuphine and pethidine for adenotonsillectomy in children with obstructive sleep disorder.

Opioids may depress respiration and contribute to airway obstruction after adenotonsillectomy for obstructive sleep disorder. We compared the respiratory and analgesic effects of nalbuphine, which has a ceiling effect for respiratory depression, and pethidine in 90 children (aged 2-12 years) with a history of obstructive sleep disorder undergoing adenotonsillectomy. Children were scored for their obstructive sleep disorder history and were randomly allocated to receive intravenously at induction of anaesthesia either nalbuphine 0.1 mg.kg-1 (group N) or pethidine 1 mg.kg-1 (group P). End-tidal carbon dioxide was measured in the recovery period using a nasopharyngeal catheter and oxygen saturation whilst breathing air; pain and sedation scores were recorded for 6 h postoperatively. Both groups were similar with respect to the demographic data and respiratory measurements: mean (SD) oxygen saturation on air in the recovery area (96.2% (1.2) vs. 96.5% (1.1) in group N and P, respectively) and mean (SD) end-tidal carbon dioxide (46.4 (5.5) mmHg vs. 47.7 (4) mmHg in group N and P, respectively). High obstructive sleep disorder score, history of apnoea, hyperactivity and loud snoring were found to be the best predictors of early postoperative oxygen desaturation in both groups.

Adenoidectomy↗
PubMed1997

Patient health management: a promising paradigm in Canadian healthcare.

Disease management, or the focused application of resources to achieve desired health outcomes, began in Canada in 1971 with the introduction of a universal healthcare program and a single government payor. Although relatively unfocused and nonrestrictive by contemporary standards, this program was successful in terms of outcomes. However, it is expensive, and Canada's rapidly aging population is fueling a growing demand for more efficacious medical therapies. As a result, isolated services are being restricted in an effort to reduce costs. As a result of these changes and low prescription and patient compliance rates for efficacious therapies, total system costs have risen, there is a growing concern about deterioration of health outcomes, and stakeholders are dissatisfied. To optimize healthcare outcomes and reduce costs, a new paradigm--patient health management (PHM)--has emerged. With PHM, clinical and cost outcomes are continually measured and communicated to providers in an attempt to promote more efficacious care. PHM also seeks to avoid restrictive practices that are now associated with detrimental health outcomes and increased costs. PHM has proved successful when applied to acute and chronic cardiac disease treatment. It remains untested for most other diseases, but available data suggest that the comprehensive, evidence-based disease and systems management that characterizes PHM is likely to achieve the best health outcomes for the most people at the lowest possible costs.

Aged↗
PubMed1995

Evaluation of a diabetes specialty centre: structure, process and outcome.

The purpose of this study was to evaluate the effectiveness of a diabetes specialty centre in assisting clients with noninsulin-dependent diabetes mellitus to improve their metabolic control and quality of life. A single-subject repeated measures design was used where data was collected on entry to the program, immediately following the 2-day education sessions, and at both 3- and 6-month follow-up visits. Structure and process were taken into consideration, and the main outcome variables measured were knowledge, attitudes, metabolic control (hemoglobin A1c) and perceived quality of life. These variables were chosen in the belief that many factors can influence behaviour and it is the combination of these factors which results in behavioural change and ultimately improvement in metabolic control and quality of life. The main findings were that the facilities and documentation records were adequate, the clients perceived that the primary function of the center was medical management rather than education, and knowledge, metabolic control and quality of life improved significantly after the program. For clients, perceived happiness and quality of life were primary issues. Therefore, improvement in quality of life should be one of the primary goals of diabetes education programs.

Diabetes Mellitus, Type 2↗
PubMed1994

Correlation of colony-forming cells, long-term culture initiating cells and CD34+ cells in apheresis products from patients mobilized for peripheral blood progenitors with different regimens.

Peripheral blood progenitor cell (PBPC) populations used for transplantation were analyzed for the presence of CD34+ cells, colony-forming cells (initial CFC), and long-term culture initiating cells (LTC-IC) cultured on irradiated stroma for 5 weeks. Thirty-eight leukapheresis products were studied from 11 patients with breast cancer, 2 with non-Hodgkin's lymphoma and 1 with ovarian cancer harvested during recovery from either cyclophosphamide (CY) chemotherapy or cyclophosphamide-VP16 with G-CSF (CY-VP-G). CY-VP-G products had a threefold higher median number of mononuclear cells collected, a fivefold higher median concentration of CD34 and LTC-IC and a threefold higher concentration of initial-CFC when compared with CY products. CY-VP-G products had a significantly higher ratio of CFU-GM to BFU-E than the CY-mobilized products. Significant correlations of r = 0.89 and r = 0.68 were observed when comparing CD34 and CFC in products from CY or CY-VP-G patients, respectively. Analysis of the regression lines indicated that slopes of these regression lines were significantly different with a ratio of CD34 to initial CFC of 15:1 in the CY-VP-G products versus 5.2:1 with the CY products. These data indicate a higher cloning efficiency of the CD34+ population in the products from CY-mobilized patients. Significant correlations of r = 0.9 (CY) and r = 0.53 (CY-VP-G) were observed when the initial CD34 concentration and the LTC-IC were compared. Comparison of initial CFC with LTC-IC also showed significant correlations (r = 0.94, CY; r = 0.58, CY-VP-G) in samples from both patient groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Peripheral blood stem cell transplantation: impact on procedure load and workload in an apheresis unit.

Peripheral blood stem cells (PBSC) reinfusion appears to hasten hematologic reconstitution following myeloablative therapy. While procurement of PBSC adds apheresis procedures, rapid engraftment could decrease the demand for platelet transfusions. To determine the impact of PBSC collection on workload in our apheresis unit, we studied 3 consecutive groups of patients with metastatic breast cancer given comparable high-dose chemotherapy and autologous bone marrow transplant, with or without PBSC or granulocyte-colony stimulating factor (G-CSF). Forty-one transplants were performed with bone marrow cells only: 31 patients (Group A) did not receive G-CSF, while the following 10 patients (group B) received daily G-CSF until neutrophil engraftment. Bone marrow cells and PBSC were used for the most recent 11 transplants (group C), followed by daily G-CSF until engraftment. PBSC were mobilized with cyclophosphamide (4 g/m2) and etoposide (1 g/m2), followed by G-CSF, 8 micrograms/kg/day. PBSC collection was carried out on a Fenwal CS3000+ cell collector, using modified procedure 1, to obtain a minimum of 5 x 10(8) mononuclear cells/kg. The times to neutrophil count over 500/microL, platelet count over 20,000/microL, and discharge from the hospital after transplant were significantly shorter for patients in group C (medians of 8, 8, and 21 days, respectively) compared to group A (medians of 14, 14, and 29 days; P = 0.001) or group B (medians of 11, 24, and 32 days; P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Effects of the eyerobics visual skills training program on static balance performance of male and female subjects.

10 male and 10 female students in physical education aged 19 to 23 yr. were each randomly assigned to both the experimental and control groups. Experimental subjects were given the 4-wk. Eyerobics visual skills training to assess its effects on static balance performance as measured on a balance stabilometer. Analysis indicated that the women performed significantly better than the men over-all. Balance performance by the trained group improved significantly.

Adult↗
PubMed1986

The new formulation of I.C.I. 35868 (propofol) as the main agent for minor surgical procedures.

Thirty unpremedicated patients for day-case surgery were anaesthetized with 2.5 mg kg-1 of a new formulation of I.C.I. 35868 (propofol: Diprivan--I.C.I.) in a lipid emulsion. An initial bolus of fentanyl (1-1.5 micrograms kg-1) was given. Anaesthesia was maintained with intermittent boluses of propofol (1 mg kg-1) with no other agent added. The significant problems were: a high incidence of pain on injection (30%) and apnoea following induction lasting more than 30 s (57%). Cardiovascular depression was significant but not considered excessive. Recovery from the drug was rapid and uneventful, with no reported hangover effect.

Adolescent↗
PubMed1985

Field dependence as a factor in sports with preponderance of open or closed skills.

Three groups of 120 male and female athletes, who were aged 13 to 22 yr. from Junior and Senior High School and College varsity sports having a preponderance of open skills or of closed skills or who were nonathletes of like age, were tested on Oltman's portable rod-and-frame apparatus to assess field dependence. Analysis indicated that individuals playing in sports with a preponderance of open skills were more field-dependent than those playing in sports with a preponderance of closed skills. Varsity participants were more field-independent than nonparticipants.

Adolescent↗
PubMed1985

Propofol ('Diprivan') infusion as main agent for day case surgery.

Propofol has been used to induce and, by continuous infusion, maintain, surgical anaesthesia in 18 patients undergoing day case gynaecological surgery. All patients received fentanyl 1.5 micrograms/kg two minutes before induction. Propofol in a dose of 2.5 mg/kg provided a smooth induction with an acceptably low incidence of pain on injection, although the incidence of apnoea following induction was high. Maintenance of anaesthesia by propofol infusion with spontaneous ventilation, without addition of nitrous oxide or volatile anaesthetic agents, proved satisfactory using a mean infusion rate of 214 micrograms/kg/min. No patient reported being aware and recovery was rapid and uncomplicated. No anaphylactoid reactions were observed.

Abortion, Induced↗
PubMed1983

Therapeutic trial of cryofiltration in patients with rheumatoid arthritis.

Cryofiltration, a new technique for on-line plasma separation and its treatment by cold filtration, enables the selective removal of immune complexes and eliminates the need for replacement proteins. Fifteen patients with rheumatoid arthritis were treated for nine to 10 consecutive sessions over a three- to five-week period. Circulating immune complexes decreased by an average of 78 percent and rheumatoid factor by 32 percent. This was accompanied by significant clinical improvement in morning stiffness, articular index, 50-foot walking time, grip strength, and target joint circumference. Cryofiltration might thus be beneficial for a subgroup of rheumatoid arthritis patients in whom conventional therapy has failed.

Arthritis, Rheumatoid↗