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Biomedical subjects

C Clemens

Publications and source records attributed to C Clemens.

9 recordsLinked to original sources
PubMed1998

Hospice care using home-based telemedicine systems.

A pilot study of telenursing for terminally ill patients at home was launched as a collaborative effort between KUMC and the Kendallwood Hospice. The service used the public telephone network. Interactive video equipment was installed in the homes of three nurses who received after-hours calls and in the homes of six hospice patients living in either Kansas or Missouri. Data concerning the utilization patterns were gathered for two separate three-month periods. Patients and caregivers reported general satisfaction with the telehospice system. Both the nurses and social worker providers became comfortable about video-calls. Nurses conducted video-assessments to determine whether an 'in person' visit was necessary. This was particularly helpful for rural patients who were living a long way from the base station. In addition, Kendallwood serves an urban population and, in certain areas, night-time nursing visits raise safety concerns.

Feasibility Studies↗
PubMed1997

Barostat review.

Explore the source record for details and available documents.

Digestive System Physiological Phenomena↗
PubMed1996

Improvement of exercise capacity with treatment of Cheyne-Stokes respiration in patients with congestive heart failure.

OBJECTIVES: The aim of this study was to determine the impact of nasal nocturnal oxygen therapy on respiration, sleep, exercise capacity, cognitive function and daytime symptoms in patients with congestive heart failure and Cheyne-Stokes respiration. BACKGROUND: Cheyne-Stokes respiration is common in patients with congestive heart failure and is associated with significant nocturnal oxygen desaturation and sleep disruption with arousals. Oxygen desaturations and arousals cause an increase in pulmonary artery pressure and sympathoneural activity and therefore may reduce exercise capacity. Oxygen is an effective treatment of Cheyne-Stokes respiration and should improve exercise capacity in these patients. METHODS: The study was designed as a randomized crossover, double-blind, placebo-controlled trial: 22 patients were assigned to 1 week each of nocturnal oxygen and room air. After each week, polysomnography, maximal bicycle exercise with expiratory gas analysis and trail-making test were performed, and a health assessment chart was completed. RESULTS: Nocturnal oxygen significantly reduced the duration of Cheyne-Stokes respiration (162 +/- 142 vs. 88 +/- 105 min [mean +/- SD]; p < 0.005). Sleep improved as evidenced by less stage 1 sleep and fewer arousals (20 +/- 13 vs. 15 +/- 9/h total sleep time; p < 0.05) as well as more stage 2 and slow-wave sleep; nocturnal oxygen saturation also improved. Peak oxygen consumption during exercise testing increased after oxygen treatment (835 +/- 395 vs. 960 +/- 389 ml/min; p < 0.05). Cognitive function evaluated by the trail-making test improved, but daytime symptoms in the health assessment chart did not improve significantly. CONCLUSIONS: Successful treatment of Cheyne-Stokes respiration with nocturnal nasal oxygen improves not only sleep, but also exercise tolerance and cognitive function in patients with congestive heart failure.

Adult↗
PubMed1996

[Nocturnal oxygen administration and cardiac arrhythmias during Cheyne-Stokes respiration in patients with heart failure].

Cheyne-Stokes respiration (CSR) is common during sleep in patients with severe congestive heart failure. It is not clear, if there is a relation between CSR and arrhythmias. Therefore in this study the impact of the nocturnal CSR on ventricular arrhythmias and the heart rate, as well as the influence of nasal nocturnal oxygen on CSR and sleep was studied. In a randomized, double-blind, crossover study 22 patients were assigned to 1 week each of oxygen and room air. The age of the patients was 57 +/- 10 years. Their mean left ventricular ejection fraction was 18.9 +/- 6.4%. Breathing oxygen significantly reduced the duration of CSR by over 50% (162 +/- 142 vs 88 +/- 106 min, p < 0.05). Sleep did improve as evidenced mainly by less arousals (21 +/- 13 vs 15 +/- 9/h total sleep time; p < 0.05) and stage 1 sleep as well as more stage 2 and slow wave sleep. Nocturnal oxygen resulted in a reduction of ventricular arrhythmias for ventricular ectopic beats (53.1 +/- 157.7 vs 44.7 +/- 97.1/h), couplets (9.0 +/- 38.3 vs 3.7 +/- 14.3/h) and tachycardias (1.8 +/- 7.2 vs 0.4 +/- 0.8/h). Due to the high day-today variability these differences were not significant, but the decrease of average nocturnal heart rate with oxygen was (71 +/- 14 vs 68 +/- 14/min; p < 0.05). In conclusion, nocturnal oxygen causes a reduction of CSR, an improvement of sleep and a decrease of arousals. A significant reduction of arrhythmias by nocturnal oxygen could not be proved.

Adult↗
PubMed1995

[Therapy of Cheyne-Stokes respiration with nocturnal oxygen therapy].

Cheyne-Stokes respiration is common in patients with severe congestive heart failure and is associated with significant nocturnal oxygen desaturation and sleep disruption. The pathogenesis of Cheyne-Stokes respiration in patients with congestive heart failure has been well described and is related to prolonged circulation time between the lung and the carotid body mainly due to increased cardiac dimensions, reduced body stores of oxygen and carbon dioxide, disturbance of ventilation and respiratory control due to arousals and a relatively high hypercapnic ventilatory response. Oxygen is likely to reduce Cheyne-Stokes respiration by increasing oxygen and carbon dioxide stores and reduces the hypercapnic ventilatory response. In the following paper we describe a study designed to determine the impact of nasal nocturnal oxygen on Cheyne-Stokes respiration, sleep, peak oxygen consumption during bicycle exercise, cognitive function evaluated by the trailmaking test and daytime symptoms in patients with severe congestive heart failure. The study is designed as a randomized, cross-over, double-blind, placebo-controlled protocol on about 20 patients with a left ventricular ejection fraction < 35%.

Arousal↗
PubMed1992

Substance misuse, emotional disturbance, and dual diagnosis in a meal-line population of mixed ethnicity.

This study investigated the rates of severe substance misuse, severe emotional disturbance, and dual diagnosis in a meal-line population of mixed ethnicity, 75% of whom were homeless and the remainder near-homeless. Alcohol and/or drug use was reported by 93% and severe substance misuse was found in 39% of the population. Severe mental illness was found in 54% of the population. Both conditions, dual diagnosis, was found in 29% of the cases. A cluster analysis of the total population found three types: those with dual diagnosis (24.27%), those with serious substance misuse and personality disorder (39.3%), and those with neither severe disorder (37.3%). The ethnicity of the homeless individual was very weakly, if at all, associated with the disorders.

Adolescent↗
PubMed1991

Acetonitrile serum concentrations and cyanide blood levels in a case of suicidal oral acetonitrile ingestion.

Acute acetonitrile toxicity is mainly dependent on the release of cyanide via hepatic metabolism. Although evaluated in animals, few data are available concerning the toxicokinetic parameters of acetonitrile and acetonitrile-liberated cyanide in human. This paper reports a case of suicidal oral acetonitrile ingestion of about 5 mL without severe symptoms of intoxication in a previously healthy adult male with a body weight of 60 kg. Acetonitrile serum concentrations as well as cyanide blood levels were determined over the whole hospitalization. The elimination half-lives calculated from these data were 32 h for acetonitrile and 15 h for cyanide. After sodium thiosulfate bolus application, the cyanide blood level rapidly decreased to 10% of the initial value, indicating that sodium thiosulfate sufficiently detoxifies acetonitrile-liberated cyanide. Since cyanide levels again increased to maximal values about 4.5 h after sodium thiosulfate application, continued thiosulfate therapy is required as predicted by the long elimination half-lives of acetonitrile and acetonitrile-liberated cyanide. Determination of cyanide and acetonitrile concentrations is recommended for the estimation of optimal individual sodium thiosulfate dosage.

Acetonitriles↗
PubMed1990

Selecting substance abusers for long-term treatment.

From a population of indigent alcoholics, those selected for long-term treatment were compared with those who were not selected on demographics, personality, and drinking history. A discriminate function analysis accurately classified 84%. The graded stepwise discriminatory variables for selection for long-term treatment were: less extreme MMPI scores on psychopathic deviance, depression, dependency, and hypochondriasis; higher scores on control and ego strength; less severe alcohol history; and slightly higher education. Only 52% of those selected completed long-term treatment. Variables associated with selection for long-term treatment found here are consistent those found associated with treatment completion in other studies. Systematic selection for these variables should improve long-term treatment completion rates.

Adult↗