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Biomedical subjects

C Cartwright

Publications and source records attributed to C Cartwright.

31 records · Page 2Linked to original sources
PubMed1997

Issues of death and dying: the perspective of critical care nurses.

A major shift in the care of terminally ill people, due to advances in technology, and the development of legislation regarding patient self-determination and autonomy, has occurred over recent years. Critical care nurses (CCNs) are involved daily in issues of death and dying and are very aware of the needs, fears and psychosocial issues of patients and their families. Professional associations see a legitimate role for nurses in assisting the dying to achieve a dignified death. For legislation, policies and guidelines surrounding end-of-life issues to be effective, and to assist nursing staff with these sensitive, often difficult concerns, it is important that data on the opinions and perspectives of CCNs be objectively obtained. In a study by the Department of Social and Preventive Medicine at the University of Queensland, questionnaires were sent to 1100 randomly sampled community members and almost 1200 health professionals (nurses, general practitioners and specialists), including 299 CCNs. The response rate of CCNs to a 30-page postal questionnaire was 79 per cent (n = 231), indicating those nurses' high levels of interest in and/or concern regarding this area. CCNs supported the use of advance directives, the appointment of proxies and the need for doctors and nurses to give sufficient medication to relieve pain, even if this hastened the death of the patient. In addition, CCNs, more than any other professional group, supported the right of the terminally ill patient to physician-assisted suicide or euthanasia, their responses being very similar to those of community members. CCNs clearly face issues which, from legal, medical and ethical viewpoints, cause them concern. In sharing their personal experiences, CCNs stressed the need for more communication between doctors and patients, as well as between doctors and nurses. In addition, CCNs saw a clear role for themselves as advocates for patients/families in the decision-making process.

Adult↗
PubMed1996

Advances in the management of AIDS-related cytomegalovirus retinitis.

Cytomegalovirus (CMV) retinitis, a common complication of the acquired immunodeficiency syndrome (AIDS), is increasing in frequency as patients infected with the human immunodeficiency virus (HIV) live longer. In recent years, the lifetime risk for CMV disease in HIV-infected persons has increased from 24.9% to 44.9%. Cytomegalovirus retinitis is usually diagnosed clinically: Almost all patients are CMV seropositive and have CD4+ counts less than 50 cells/mm3. Specific diagnostic tests that use antigen detection or quantitation of circulating nucleic acid to detect CMV are being developed, but they have not been validated for routine clinical use. Such tests would help predict disease, diagnose acute retinitis, and monitor therapy. Therapy with systemic agents, including intravenous ganciclovir, intravenous foscarnet, and intravenous cidofovir, is effective. However, it is cumbersome, costly, and associated with considerable toxicity, therapy encouraging investigation of other therapeutic approaches. Intravitreous injections with antiviral agents are effective, but the short half-life of available agents makes these injections inconvenient. Intraocular implants that slowly release ganciclovir have been effective for both acute therapy and long-term maintenance, but they need to be directly compared with intravenous and oral regimens to determine which regimen will optimally maximize convenience, preserve vision, and improve survival. Cytomegalovirus retinitis could be prevented by improved antiretroviral therapies or by immune-based therapies that would prolong the time during which patients remain immunocompetent. Once patients become immunologically susceptible to CMV end-organ disease (when their CD4+ counts decrease to < 50 cells/ mm3), specific chemotherapy with oral ganciclovir is promising, but the cost, inconvenience, toxicity, and conflicting reports of efficacy associated with this strategy mean that it needs careful assessment before it can be considered standard treatment. Management of CMV retinitis is on the verge of major changes. In the next few years, improvements in diagnostic, therapeutic, and preventive tools should reduce morbidity and mortality from this disease.

AIDS-Related Opportunistic Infections↗
PubMed1996

Agreement between the Takeda UA-731 automatic blood pressure measuring device and the manual mercury sphygmomanometer: an assessment under field conditions in Newcastle upon Tyne, UK.

STUDY OBJECTIVE: To assess agreement between two Takeda UA-731 automatic blood pressure measuring devices (referred to as machines A and B) and two manual mercury sphygmomanometers. DESIGN: A 'Y' connector attached each Takeda UA-731 to a manual mercury sphygmomanometer. Simultaneous measurements were made on adult subjects. SETTING: A population based cardiovascular disease survey in Newcastle upon Tyne, UK. PARTICIPANTS: Measurements on machine A were compared in 71 individuals (all women), and on machine B in 75 individuals (9 men, 66 women). The age range of subjects was 28 to 76 years and median ages were 59 years for machine A and 50 years for machine B. MAIN RESULTS: Blood pressure (mmHg) ranged from 72 to 212 systolic and 44 to 102 diastolic. Both Takedas gave significantly lower readings than the manual devices for systolic and diastolic pressures: differences were mean (SD: 95% CI) 3.7 mmHg (6.5: 2.2, 5.2) for machine A systolic, 2.3 mmHg (4.5: 1.3, 3.4) machine A diastolic; 1.8 mmHg (6.2: 0.4, 3.3) machine B systolic, and 1.8 (4.4: 0.8, 2.8) machine B diastolic. On the British Hypertension Society criteria, machine A was graded C on systolic measurements and B on diastolic; machine B was graded B on both systolic and diastolic measurements. CONCLUSIONS: The performance of these machines compares favourably with the Dinamap 8100, recently adopted for survey work by the Department of Health. The Takeda UA-731 looks promising for epidemiological survey work but before it can be fully recommended further evaluations are needed.

Adult↗
PubMed1994

Spectacle and contact lens wearing six years after radial keratotomy in the Prospective Evaluation of Radial Keratotomy Study.

BACKGROUND: Patients in the Prospective Evaluation of Radial Keratotomy (PERK) Study stated that a major reason for obtaining radial keratotomy was to see without dependence on corrective lenses. The authors examined lens-wearing patterns 6 years after surgery. METHODS: Of the 435 patients in the PERK Study, the authors analyzed the responses of 328 (75.4%) who elected to have surgery on both eyes, who completed a questionnaire at 6 years, and for whom visual acuity and cycloplegic refraction were available. RESULTS: Sixty-four percent (106/167) of patients younger than 40 years of age and 38% (64/161) of patients older than 40 years of age wore no lenses for distance or near vision. The proportion of time lenses were worn increased with age for those who wore them for close work only (from 18% younger than 40 years of age to 25% older than 40 years of age) and decreased with age for those who wore them for distance only (from 41% to 27%). The authors examined the visual acuity and refractive error criteria for patients to be free of distance lenses. Of the 359 patients who saw 20/20 or better uncorrected in one or both eyes, 77% (n = 198) wore no distance correction, whereas of the 53 patients who saw 20/25 to 20/40 in both eyes or their best eye, only 34% (n = 18) wore no distance correction. Of the 72 patients with a residual refractive error of +/- 0.50 diopters (D) in both eyes, 85% (n = 61) wore no distance correction, whereas of the 87 patients with +/- 1.00 D in both eyes, only 39% (n = 34) wore no distance correction. Of the 328 patients, 60% (n = 197) were highly satisfied with the results of surgery, and satisfaction was primarily predicted by having a visual acuity 20/20 or better in at least one eye and not wearing spectacles for distance vision. Before surgery, 57% of patients reported worrying about their eyesight and 47% reported restrictions in activities because of their eyes; these rates dropped to 31% and 9%, respectively, at 6 years. Of the 328 patients, 74% (n = 243) said their preoperative goals were completely met and 94% (n = 308) said they would have radial keratotomy again. CONCLUSION: The use of 20/40 uncorrected visual acuity and a residual refractive error of +/- 1.00 D were insensitive criteria for evaluating distance spectacle independence. The ability to function without lenses increased substantially only when patients had an uncorrected visual acuity of 20/20 or better in at least one eye, and a refractive error within +/- 0.50 D.

Adult↗
PubMed1986

Reported satisfaction, fluctuation of vision, and glare among patients one year after surgery in the Prospective Evaluation of Radial Keratotomy (PERK) Study.

We studied satisfaction with the results of radial keratotomy one year after surgery on one eye as reported by 354 patients in the Prospective Evaluation of Radial Keratotomy (PERK) Study. We measured satisfaction using an index based on ten questions that were part of a longer psychometric questionnaire. Patients were generally satisfied with the results of radial keratotomy-48% were very satisfied, 42% were moderately satisfied, and 10% were dissatisfied. A lot of trouble with fluctuating vision was reported by 12% of patients before surgery and by 34% one year after surgery; 17% reported a lot of trouble with glare both before surgery and one year after surgery. The three major factors that influenced satisfaction were uncorrected visual acuity, residual refractive error, and subjective daily fluctuation in vision. A multiple regression equation that incorporated these three variables, glare, and patient sex was able to predict only 46% of the variance in patient satisfaction.

Adult↗
PubMed1983

The leukocyte composition of peripheral blood buffy coat.

To assist in the interpretation of buffy coat smears from leukopenic patients, we determined the composition of the buffy coat of the blood of normal volunteers. Leukocytes were concentrated by centrifugation in microhematocrit tubes. Stained smears of these cells showed minor differences in the proportions of neutrophils, lymphocytes, and monocytes when compared to unconcentrated peripheral blood. Granulocytes of greater immaturity than the metamyelocyte were not encountered, and their presence should suggest the possibility of marrow dysfunction. Occasional young monocytoid cells and "stimulated" lymphocytes were seen.

Adult↗
PubMed1983

Management of acute diarrhea.

Acute diarrhea in adults is usually caused by bacterial infection, parasitic infestation, food poisoning, or drugs. In this review, we summarize the pros and cons of medical therapies, point out certain areas of controversy, and propose a rationale for early intervention. Discussion is limited to the use of antidiarrheal agents and antibiotics in acute infectious diarrhea.

Acute Disease↗