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Biomedical subjects

C Sharp

Publications and source records attributed to C Sharp.

16 recordsLinked to original sources

How should parents be informed about major procedures? An exploratory trial in the neonatal period.

The current doctrine of informed consent in medical practice may require the provision of more information than is understandable or desired by some parents. We conducted an exploratory trial comparing: (1) detailed risk/benefit disclosure provided both verbally and in writing and (2) flexible disclosure consisting of a brief verbal description supplemented with detailed verbal and written disclosure if desired by the mother. Information about mechanical ventilation was presented to 26 mothers of newborns at risk for respiratory failure. Of the 13 mothers in the flexible disclosure group, seven (54%) desired only brief verbal disclosure. Despite poor recall of information, most mothers were satisfied with the information provided. There was no evidence that the detailed disclosure group had greater maternal satisfaction or less maternal anxiety. Flexible disclosure as evaluated in this study had no important disadvantages relative to detailed disclosure. Methods of providing information to better meet the wants and needs of parents deserve further study.

Adolescent

Carbachol-induced down-regulation of receptors for pancreatic secretagogues.

Pancreatic acini possess a high affinity class of cholinergic receptors and a low affinity class of cholinergic receptors. Carbachol occupation of high affinity cholinergic receptors produces a reduction in binding of [3H]N-methylscopolamine. First incubating acini with carbachol caused a complete loss of high affinity cholinergic receptors with no change in the number or affinity of low affinity cholinergic receptors. Carbachol occupation of low affinity cholinergic receptors appears to produce a reduction in binding of 125I-CCK-8 and 125I-[Tyr4]bombesin. Acini possess two classes of CCK receptors. One class has a high affinity for CCK-8; the other class has a low affinity for CCK-8. First incubating acini with carbachol caused a 60% decrease in the number of high affinity CCK receptors with no change in the number of low affinity receptors or the affinities of either class of receptors for CCK-8. Acini possess a single class of bombesin receptors and first incubating acini with carbachol caused a 40% decrease in the number of bombesin receptors with no change in their affinity for bombesin.

Animals

Risk factors for median sternotomy dehiscence in cardiac surgery.

We retrospectively reviewed several risk factors for median sternotomy dihiscence in our cardiac surgery patients for a recent 18-month period. We studied these factors by univariate and multivariate analysis with respect to sternal dehiscence. Univariate analysis showed several factors to be significant: female sex (P = .03), obesity (P = .002), diabetes (P = .01), and prolonged postoperative ventilation (P = .006). Mammary artery bypass versus saphenous vein bypass only approached significance (14% vs 3%, P = .11). Multivariate analysis showed obesity (P = .002), diabetes (P = .041), and prolonged postoperative ventilation (P = .005) to be important. We conclude that obese diabetic women are at extremely high risk for sternotomy dehiscence, and mammary artery bypass in this high-risk population may be a relative contraindication.

Adult

The relationship of gestational age to reserve albumin concentration for binding of bilirubin.

The authors studied bilirubin binding ability in the umbilical cord serum of 68 newborn infants ranging in gestational age from 18 to 42 weeks. There was no correlation between gestational age and the binding fraction (i.e., the ratio of the potential bilirubin binding concentration to the albumin concentration). Previous reports of the relationship between gestational age and bilirubin binding ability used bilirubin data derived from samples drawn at variable times after birth and probably reflect the unexplained effect of illness on bilirubin binding.

Bilirubin

Rapid loss of stimulus-specific satiety after consumption of a second food.

'Meals' consisting of several differently flavoured 'courses' result in greater consumption than meals consisting of identical courses. Experiment 1 confirmed that this effect is found in rats during the dark phase of a LD 12:12 cycle. Two subsequent experiments demonstrated that meals consisting of three or four courses in which only two flavours were alternated produced as great an enhancement of consumption as meals in which each course was differently flavoured. The implications of this result are discussed for the nature of the processes underlying the generation and reversal of this stimulus-specific aspect of satiety.

Animals

Pediatric residents' assessment of adolescents' experiences during pelvic examination.

We compared male and female pediatric residents' perceptions of adolescent females' attitude and experience during a pelvic examination. Females (n = 112) ages 12-19 years were randomly assigned to a male of female examiner and to a supine or semisitting pelvic-examination position. Pre- and postexamination questionnaires were completed by the patients. Female physicians were more accurate in assessing patient discomfort (p less than 0.006),pain (p less than 0.0004), and embarrassment (p less than 0.0006) during the pelvic examination. The correlation between the physicians' and the patients' assessments of the completeness of the examination was stronger for the male physicians (p less than 0.003). These relationships remained constant for both positions. The female physicians' appeared to base their perceptions of the patient-physician relationship partly on the emotional responses of the patient such as embarrassment, fear, and relaxation (p less than 0.02). In contrast, male physicians' perceptions were associated with patient expressions of pain and discomfort (p less than 0.02).

Adolescent

Digital swelling following long-term administration of prostaglandin E1 in an infant.

A premature infant with hypoplasia of the right heart and pulmonary arteries required treatment with prostaglandin E1 (PGE1) for 107 days prior to surgical intervention. Digital swelling was noted at 40 days of age. Swelling was measured by determining the ratio of the distal phalangeal depth to interphalangeal depth. The ratio declined from 1.16 to 0.94 in the first 64 days after treatment. We believe digital swelling is a reversible complication of PG therapy.

Fingers

Influence of position during examination, and sex of examiner on patient anxiety during pelvic examination.

It has been reported that adult women prefer the semi-sitting position over the supine position for the pelvic examination. We determined the effect of the pelvic examination position and the examiner's gender on adolescent anxiety with the pelvic examination. Adolescent girls (n = 112) aged 12 to 19 years were randomly assigned to a semi-sitting or supine position and to a male or female physician. Before and after the examination questionnaires containing the Spielberger State-Trait Anxiety Inventory and other scales were administered. There were no differences between the groups in pre-examination anxiety or concern. Patients in the semi-sitting group reported fewer negative responses during the examination when examined by a male physician (P less than or equal to 0.009); those in the supine group reported fewer negative responses when examined by a female physician. These findings persisted after controlling for previous pelvic examinations, frequency of sexual activity, and Tanner stage. Patients who had previously had a pelvic examination and were examined in the semi-sitting position by a male physician reported the lowest levels of post-examination anxiety (P less than or equal to 0.02). Patients who had never had a pelvic examination expressed less anxiety if they were examined in the semi-sitting position by a female physician. These data suggest that the patient's previous history of pelvic examinations and the gender of the examiner should be considered when selecting the pelvic examination position.

Adolescent

1028 neonatal electrocardiograms.

Electrocardiograms were recorded from 1028 (99.4%) of 1034 consecutively born babies on the 1st or 2nd day of life. Abnormalities of cardiac rhythm or conduction were found in 49 (4.8%) babies. 17 babies had single or multiple premature beats during the recordings, and 7 babies showed sudden increases in R-R interval possibly due to sinoatrial node dysfunction. One baby had sinus or junctional bradycardia of less than 80 beats/min. One baby had an incessant reciprocating tachycardia and subsequently required digoxin for heart failure. Continuous 24-hour ECG monitoring in 25 babies with abnormalities of the screening ECG, and 25 babies without such abnormalities, failed to show any additional tachyarrhythmias or bradyarrhythmias warranting treatment. In view of the uncertain clinical significance of many neonatal arrhythmias and cardiac conduction disorders, more information concerning their natural history and relationship to sudden unexpected death in infancy is needed before recommending that neonatal ECG screening be generally adopted.

Arrhythmias, Cardiac