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Biomedical subjects

C Delaney

Publications and source records attributed to C Delaney.

16 recordsLinked to original sources
PubMed1992

Standardized nursing language for healthcare information systems.

Since a substantial component of health care delivery is reflected in nursing's work, it is imperative that nursing expedites implementation of a standardized language that reflects nursing's work and ultimately allows outcome evaluation. This paper will summarize the state of development and related issues of standardized language in nursing, including: Nursing Minimum Data Set, Taxonomies of Nursing Diagnoses, Nursing Interventions, Outcomes, and the Nursing Management Minimum Data Set. The Nursing Minimum Data Set, including nursing care, patient or client demographic, and service elements, reflects a standardized collection of essential nursing data used by multiple data users in the health care delivery system across all types of settings. The nursing care elements include nursing diagnosis, nursing intervention, nursing outcome, and intensity of nursing care. Currently, more than 100 nursing diagnoses have been accepted for clinical testing by the North American Nursing Diagnosis Association (NANDA) and have been incorporated into a taxonomy of nursing diagnoses that reflects patient responses to actual or potential health problems that nursing can address. A current formulation of a taxonomy of nursing interventions for the treatment of the nursing diagnoses yielded 336 nursing intervention labels organized at three or four levels of abstraction. Concomitant with these endeavors is the necessity for identifying outcomes associated with each diagnosis and its treatment. Concepts and a classification for indicators of these outcomes are being reviewed. Last, to address the contextual covariates of patient outcomes, a collection of core variables needed by nurse managers to make management decisions and compare nursing effectiveness across institutions and geographic regions is under development. In summary, standardized measures to determine cost effective, high quality, appropriate outcomes of nursing care delivered across settings and sites are being developed.

Classification↗
PubMed1992

Spinal stabilisation in Duchenne muscular dystrophy.

Of 55 patients with Duchenne muscular dystrophy offered surgical stabilisation of the spine, 32 accepted and 23 refused. We compared both groups pre-operatively and at six-month intervals in respect of survival, forced vital capacity, peak expiratory flow rate and severity of scoliosis. In the nonoperated patients, the forced vital capacity deteriorated by a mean of 8% per annum; in the operated group it remained static for 36 months and diminished slightly thereafter. Spinal stabilisation resulted in an improvement in the peak expiratory flow rate which was maintained for up to five years. In the nonoperated patients the scoliosis progressed from a mean of 37 degrees to a mean of 89 degrees at five years; in the stabilised spines it was improved from a mean of 47 degrees to a mean 34 degrees at five years. There was significantly improved survival in the patients who had undergone spinal stabilisation.

Adolescent↗
PubMed1991

The role of 3 hour distal oesophageal pH monitoring in gastro-oesophageal reflux.

It has been suggested in the literature that an eight hour period of distal oesophageal monitoring is adequate for the diagnosis of reflux in symptomatic patients. The aim of this study was to investigate whether 3 hour intra-oesophageal pH-metry could be substituted for the eight hour test period without loss of sensitivity in the diagnosis of GOR. Twenty patients were tested, 10 of whom had classical De Meester symptoms of GOR and 10 asymptomatic patients served as controls. All were commenced on 3 hour ambulant pH monitoring of the distal oesophagus. This was followed by a separate period of 8 hour testing. Each test had a 50% supine time period. The following variables were determined: (i) number of reflux episodes (ii) number longer than 5 minutes (iii) longest episode of reflux, (iv) percent of time that pH was below 4. Results are analysed using the 'Esophogram' computer program. 8 hour monitoring resulted in a positive diagnosis of GOR in 10 of 10 patients, giving an overall sensitivity of 100%. 3 hour testing was positive in 8 patients (sensitivity of 80%). The best correlations were obtained when comparing total reflux episodes, and the percent of total time pH less than 4, but overall the tests correlate poorly for individual variables. None of the controls had positive 3 or 8 hour testing. We conclude therefore, that 3 hour pH metry may be a useful screening test to confirm symptomatic reflux, and can be performed within a single clinic visit. If negative, arrangements must be made for more prolonged monitoring.

Female↗
PubMed1990

The effect of caerulein induced pancreatitis on the hepatic microvasculature.

A three-dimensional morphological study of the hepatic microvasculature in caerulein induced oedematous pancreatitis was performed using scanning electron microscopy (SEM) vascular casts and transmission electron microscopy (TEM) of hepatocytes and hepatic sinusoids. TEM studies provided ultrastructural evidence of hepatocellular damage while SEM views demonstrated gross irregularity of the sinusoidal outline with abruptly terminating sinusoidal buds and extravasation of cast material, findings which were similar to those previously reported in the pancreas itself using the same model and which were supported by TEM cross-sectional views of the hepatic sinusoids. The results suggest that caerulein induced pancreatitis is associated with extrapancreatic microvascular damage which may be an important factor in the pathogenesis of extrapancreatic organ impairment associated with acute pancreatitis.

Amylases↗
PubMed1989

Synaptic density of caudate-putamen and visual cortex following exposure to ethanol in utero.

Pregnant Long-Evans rats were fed a liquid diet containing ethanol (30% of total calories) during days 3-19 of gestation. Controls were given ad libitum access to liquid diet lacking ethanol, or pair-fed isocaloric amounts based on consumption by the animals in the ethanol group. Brain development of female offspring was evaluated by analysis of electron micrographs of caudate-putamen and visual cortex. Numbers of presynaptic terminals and synaptic junctions (synaptic density) per unit area were compared for 14- and 28-day-old offspring of dams from the three treatment groups. Synaptic density of the caudate-putamen and visual cortex was not affected by ethanol at 14 or 28 days. Although exposure to ethanol during a period comparable to the first two trimesters of human development with minimal or no undernutrition did not affect numerical density of synapses in visual cortex or caudate-putamen, synaptogenesis of caudate-putamen was altered in offspring of pair-fed animals.

Animals↗
PubMed1989

Concordance between different measures of small sensory and autonomic fibre neuropathy in diabetes mellitus.

This study presents concordance data from 3 different tests of small nerve-fibre function on the same diabetic patients and also examines the effects of hyperglycaemia. Thus the TTT-Glasgow automated thermal threshold test, EAR-Electrically evoked axon reflex flare, and GOE-Gastric emptying of a mixed sold/liquid meal and oesophageal emptying of a solid bolus were all measured on 25 diabetic patients. The TTT, EAR and GOE all gave values ranging from within the normal reference range for non-diabetics to markedly dysfunctional readings. Mean warm perception (WPT) on the foot dorsum averaged 0.73 degrees C +/- 0.93 for normal controls, but was 4.67 degrees C +/- 3.99 in the 25 diabetics. Cold perception thresholds (CPT) were 0.48 degrees C +/- 0.55 for normal subjects and 3.75 degrees C +/- 4.28 for diabetics. In the same normal subjects the mean EAR flare laser flux responses (for 8 and 16 noxious TENS pulses) was 2.8 V.min, while for diabetics the mean was 0.2 V.min. Solid and liquid gastric 50% emptying times and oesophageal emptying for non-diabetics were within normal range (mean 78 min and 18 min, 18 sec respectively) but for the 25 diabetics emptying times ranged from normal to very prolonged (mean 114 min and 30 min, 68 sec respectively). A plot of 3 measured variables (TTT, EAR and GOE) showed a high degree of correspondence between the gastro-oesophageal emptying delays and the presence of reduced electrical axon reflex and elevated thermal thresholds. Of 25 patients, 6 could be classed as within normal limits on all 3 variables, but 8 of 25 displayed objective evidence of C-fibre neuropathy--thermal perceptual impairment (C- and A-delta sensory fibres), reduced neurogenic inflammatory flare (peptidergic nociceptive afferents) and delayed gastro-oesophageal emptying (vagal afferent/efferent fibres).

Autonomic Nervous System↗
PubMed1988

Development of axonal-oligodendroglial relationships and junctions during myelination of the optic nerve.

The early stages of myelination were examined in optic nerves of rats aged 12-15 days. The initial association between oligodendroglial processes and bare axons involves no junctional specialization, as the axoglial extracellular space remains unaltered. Following ensheathment by a collar of glial cytoplasm, at least one full rotation of mesaxon was evident before compact myelin formed. Furthermore, myelin was generally evident before a second rotation was completed. In longitudinal sections, an axoglial junction was always observed beginning on the first paranodal loop, continuing through to the last (or outermost) loop. Thus, the formation of myelin and elaboration of a junctional complex in the paranodal region follow a promyelination phase and appear to be synchronous (and possibly related) events. Although the paranodal plasmalemma and axolemma are in close apposition, there is a material in the extracellular space that precipitates phosphotungstic acid, a characteristic that appears to be featured in a number of different types of cell junctions.

Animals↗
PubMed1988

Effects of topical capsaicin on normal skin and affected dermatomes in herpes zoster.

Hyperalgesia and allodynia, lasting for months or even years, occurs in the form of post-herpetic neuralgia in approximately 70% of adults previously infected with the varicella herpes zoster virus. The present study aimed at testing the analgesic desensitising actions and reversibility of repeated application of topical capsaicin on disordered polymodal nociceptors and peptidergic sensory fibres mediating warm and pain sensation. Cutaneous nociceptor desensitisation was measured using the Glasgow automated thermal threshold test (Medelec TTT). For normal subjects (n = 69) the mean forearm warm threshold was 0.15 +/- 0.07 degrees C and the cold threshold was 0.14 +/- 0.10 degrees C. A variable degree of partial desensitisation of herpes-affected skin was found in 15 patients with post-herpetic neuralgia before capsaicin treatment where the mean threshold elevation for warm detection was 1.19 degrees C and 0.7 degrees C for cold detection, compared with the corresponding normal skin. In preliminary studies of 15 patients with post-herpetic neuralgia, good pain relief averaging 30% or 77% occurred in the affected dermatome(s) after 3 to 4 weeks of 0.01% or 0.05% capsaicin cream respectively, applied 3-4 times daily. The warm thresholds, after chronic capsaicin treatment, increased between 0.1 and 7.60 degrees C, the average elevation being 3.69 degrees C. By contrast cold thresholds after capsaicin altered inconsistently and by only an average of 0.08 degrees C. The results suggest that elevation of the warm threshold may indicate the desensitisation achieved by capsaicin treatment of skin polymodal nociceptors. Cold detection, being dependent upon A-delta cold fibre function, is unaffected by capsaicin treatment. There was a poor correlation between pain relief and elevation of warm detection in response to capsaicin treatment. Generally, it was found that those patients with less initial desensitisation to warm detection as a consequence of post-herpetic neuralgia experienced better pain relief after capsaicin was applied. The method used permits determination of the minimum effective desensitising dose of capsaicin, enables patient compliance and progress to be monitored and should allow the prediction of patients likely to achieve the best response to treatment.

Administration, Topical↗
PubMed1985

Effect of exercise on longevity, body weight, locomotor performance, and passive-avoidance memory of C57BL/6J mice.

Studies of human and animal subjects have suggested that exercise may retard aging, help prevent age-related diseases, and prolong life span. Earlier studies focused on the effects of exercise on the heart, skeletal muscles, lungs, metabolism, and longevity. Researchers recently have begun to direct their attention to possible benefits of exercise on the brain. The goals of this study were to examine the effects of voluntary wheel-running exercise on life span, body weight, food and water intake, locomotor performance, and one-trial passive-avoidance memory of mature (10-14 month), middle-aged (20-24 month), and old (28-30 month) C57BL/6J male mice. No significant differences in life span, expressed in months, were found between control and exercised mice when exercise was carried out during maturity, senescence, intermittently across both periods, or continuously throughout maturity and senescence. Exercised adult mice maintained body weight compared to adult controls, an effect not apparent in old mice. Locomotor performance was reduced in old mice, and exercise increased performance much more in adult than in old mice. In the passive avoidance test of recent memory, exercise significantly increased latency, that is, it improved retention, in adult, middle-aged, and old mice. The effect was greatest in middle-aged, next in old, and lowest in adult mice. The findings indicate that exercise may be an important modulator of the rate of aging.

Aging↗
PubMed1982

Contract grading in clinical evaluation.

The use of contracts in grading clinical performance has provided faculty with a solution to two important problems. One has been how to ensure that students are graded consistently among the various faculty who are grading the same clinical component of a course. The second has been to increase the opportunity for individualized attention to student learning needs. We have been pleased to see all the faculty members increase their input and involvement in the continuing modifications of the contract. Although we have taken the major responsibility for the semi-annual revisions of the contract, other faculty members have been increasingly more explicit in their evaluations and suggestions as their experience with the contract has expanded. Their confidence in this method of clinical evaluation has increased with each semester of use. We plan to continue in the refinement of the instrument and will develop materials for the use of other faculty groups who are interested in developing similar contracts. We are also designing a survey to attempt to discover how widespread is the use of contract grading in clinical areas.

Clinical Competence↗
PubMedDate not supplied

Validation of defining characteristics of four nursing diagnoses using a computerized data base.

As the use of nursing diagnoses in clinical practice increases, systematic research is necessary to appropriately validate them. Validity studies could be expedited by the use of information technology and computerized clinical data bases. The purpose of the following descriptive study was to validate the defining characteristics (risk factors for potential diagnoses) of the four nursing diagnoses related to alterations in fluid volume proposed by the North American Nursing Diagnosis Association using a nursing minimum data set (NMDS) collected from a computerized nursing data base. A sensitivity measure, the proportion of subjects with specific defining characteristics for a given diagnosis among the total number of subjects with the respective diagnosis, was used to estimate validity. The study was conducted in a 265-bed, mid-western, community hospital in which computerized nursing diagnosis care planning is used. The elements of the NMDS and defining characteristics were collected from a systematic sample (N = 191). The sample consisted of a proportion of about half of computerized discharge patient care plan summaries from each of the four diagnostic labels related to alteration in fluid volume obtained from medical records during the 1987 calendar year. Discharge patient care plan summaries contained at least one of four nursing diagnoses related to alteration in fluid volume. The results show the existence of individual defining characteristics as well as combinations of defining characteristics meeting validation criteria for each diagnostic label. Never-documented defining characteristics also were identified.

Adolescent↗
PubMedDate not supplied

A nursing management minimum data set. Significance and development.

Building on Werley's nursing minimum data set, the authors identified a nursing management minimum data set (NMMDS). This collection of core data elements is needed by nurse administrators to make management decisions and compare effectiveness across institutions.

Data Collection↗
PubMedDate not supplied

Creating a resource database for nursing service administration.

In response to the current information explosion in nursing service administration (NSA), the authors felt a need to collect and organize available resources for use by their faculty and graduate students. An electronic database was developed to facilitate the use of the collected print and software resources. This article describes the creation of the NSA Resource Database from the time the need for it was realized to its completion. There is discussion regarding the criteria used for writing the database, what the database screens look like and why and what the database contains. The article also discusses the use and users of the NSA Resource Database to date.

Databases, Bibliographic↗