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Biomedical subjects

D Adams

Publications and source records attributed to D Adams.

At least 91 records · Page 5Linked to original sources
PubMed1994

Serum cortisol levels are related to moods of elation and dysphoria in new mothers.

Serum cortisol levels were measured in 163 women on the third day after childbirth. Significantly elevated levels of cortisol were found to be associated with the "blues," and significantly lower levels characterized women who exhibited mild hypomania (the "highs"). Low levels of cortisol were independently associated with epidural anesthesia, while elevated levels were related to assisted delivery. There was no significant association with breast or bottle feeding. Changes in serum cortisol were thus found to parallel the mild bidirectional changes in affect that frequently follow childbirth.

Adult↗
PubMed1994

Dysphoria and immune status in postpartum women.

This study investigated the relationship between psychological factors and circulating immune cell populations in postpartum women. The study group was 75 women who had vaginal deliveries and were free of psychotropic medication. Four days postpartum each subject completed three mood questionnaires, and a small blood sample was taken. All questionnaire scores were shown to be highly inter-correlated and principal component factor analysis revealed a single factor which we term dysphoria. This factor was significantly associated with lower total circulating lymphocyte counts. The effect was strongest for T cells (largely attributable to a reduction in CD4+ ve T helper cells) and weaker for NK cell counts. No evidence was found of a mediating role for serum cortisol although serum cortisol levels were weakly related to immune status. This study has thus demonstrated that changes in the distribution of the lymphocyte pool are associated with relatively minor differences in postpartum affect.

Adolescent↗
PubMed1994

Prevention of rebleeding from oesophageal varices: two-year follow up of a prospective controlled trial of propranolol in addition to sclerotherapy.

A prospective randomised trial comparing propranolol and sclerotherapy to sclerotherapy alone was conducted over a 2-year follow up in a district hospital setting of unselected patients. Rebleeding and survival were analysed. Thirty-nine patients were randomised to propranolol plus sclerotherapy and 34 to sclerotherapy alone. The two groups were clinically comparable. There was no significant difference in the cumulative percent of patients free of rebleeding; 54% of the sclerotherapy group rebled compared to 52% of the group treated with propranolol plus sclerotherapy (Hazard ratio 1.09 (0.54-2.22) and p = 0.81, NS). Two-year actuarial survival was also not significantly different, with 77% of the propanolol plus sclerotherapy group surviving, compared to 74% of sclerotherapy alone (Hazard ratio 1.08 (0.35-2.22) and p = 0.79, NS). The mean time to eradication of varices was not significantly different between the two groups (propranolol plus sclerotherapy 222 days, sclerotherapy alone 243 days), nor did the rate of variceal recurrence differ (72.7 vs 72 days). This study did not show long-term improvement in rebleeding or survival using propranolol in addition to a regular sclerotherapy programme.

Adolescent↗
PubMed1994

Planning for patient care redesign: success through continuous quality improvement.

A key to improving patient care in hospitals is the use of staff nurses on a continuous quality improvement team to redesign the patient care delivery model. This article describes the planning process and strategies for patient care delivery redesign on a medical-surgical unit in a small community hospital. A team of 12 staff nurses working with trained facilitators and a team leader began the seven-month project. The article describes how the team assessed the needs of the customers, developed a plan for a pilot, and drafted evaluation criteria.

Hospital Bed Capacity, under 100↗
PubMed1994

Mouthrinses.

Mouthrinses have been used for centuries for medicinal and cosmetic purposes, but it is only in recent years that the rationale behind the use of the ingredients has been subject to scientific research and clinical trials. Although Listerine held its position for many years in the vanguard of the anti-plaque agents, the advent of mouthrinses containing chlorhexidine was a major breakthrough in the research for a chemical means to prevent disease. Since that time, and especially in the past ten years, the number of formulations that claim to have anti-plaque, anti-calculus, and anti-caries activity has increased, and much emphasis has been placed on such substances as an adjunct to, or indeed to replace, conventional toothbrushing techniques. This review covers the literature on mouthrinses over the past five years, concentrating more on the anti-plaque, anti-gingivitis, and anti-calculus formulations. In the first section, the methods of conducting clinical trials of mouthrinses are discussed, and a plea is made for a greater degree of standardization of methodology with agreed acceptable levels of clinical benefit. Trials of established mouthrinses are considered, and the advantages and disadvantages of several newer formulations discussed. From the review, it appears that chlorhexidine has no equal in its effects on reduction of plaque and gingivitis, but major drawbacks lie in the taste and stain-producing problems. The pre-brushing rinse, Plax, does not have unqualified success in all trials, though the more recent European formulation may have promise. Newer rinses which inhibit bacterial adhesion to tooth surfaces also appear promising, and it is suggested that more work on combinations of active ingredients is necessary.

Chlorhexidine↗
PubMed1994

Mild hypomania (the highs) can be a feature of the first postpartum week. Association with later depression.

About 10% of women show elation and associated features of hypomania in the first 5 days following childbirth. These symptoms can be detected using a self-rating scale (the 'Highs') based on SADS-L criteria. This phenomenon has been confirmed using the observer-rated Comprehensive Psychopathological Rating Scale, which also revealed a high degree of related irritability. Significantly more women scoring > or = 8 on the Highs scale at 3 days postpartum went on to manifest depression at 6 weeks than did subjects with no psychopathology in the early puerperium. It is suggested that the 'highs' followed by depression may be a mild and common form of bipolar disorder.

Adult↗
PubMed1994

The future and long-range planning of healthcare services: a Saskatchewan perspective.

The Canadian health system is built upon five key principles: universality; accessibility; comprehensibility, public administration; and portability. Since the 1960s, the primary feature of the Canadian health system has been the universal provision of 'insured' services without direct cost to consumers. Funding for Canadian health care is derived primarily from the federal and provincial governments. Through this funding arrangement, the Canadian health system is primarily a 'public' enterprise in that the majority of funding is derived from taxation at either the federal or provincial level. Since its inception, this model of health coverage has been very popular with the Canadian public, since it provides all citizens with reasonable access to the insured services and accommodates the portability of those services. The model has also provided some measure of cost containment, primarily as a result of its public administration. However, the Canadian model in its present form has several significant shortcomings which has precipitated a need for change. The author discusses these.

Canada↗
PubMed1993

The dental status and attitudes of patients at risk from infective endocarditis.

Infective endocarditis represents one of the few potentially fatal infections that may be caused in the patient by a dentist. Efforts to reduce the incidence of this disease usually take the form of appropriate antibiotic cover prior to dental treatment, together with the establishment and maintenance of good oral health. This paper is a report of a survey on the dental health and awareness of 81 'at-risk' patients attending a cardiology outpatient clinic. It was found that whilst the patients were apparently well motivated and well informed, a high prevalence of periodontal disease existed in the group. It is concluded that when patients are diagnosed with a cardiac disorder which predisposes to infective endocarditis they should have a dental examination as soon as possible, preferably by a dentist experienced in the treatment of patients with special needs.

Anti-Bacterial Agents↗
PubMed1993

Gadolinium-enhanced MRI in central nervous system Behçet's disease.

Two cases of central nervous system Behçet's disease, studied by gadolinium-enhanced MRI, are presented. In one patient, whose clinical picture was dominated by a brain syndrome, the gadolinium enhancement resolved with clinical improvement, although the hyperintense areas in the mesencephalon on T2-weighted images persisted. In the second, who had a pseudobulbar palsy and a mild right hemiparesis, there were many abnormal areas, but an enhancing focus in the posterior limb of the left internal capsule was probably the lesion responsible for the hemiparesis.

Adult↗
PubMed1993

Late-onset familial amyloid polyneuropathy with the TTR Met 30 mutation in France.

Four unrelated French cases of familial amyloid polyneuropathy are reported. Clinical onset ranged from the sixth to the ninth decade. Sensory signs were predominant initially in the lower limbs; motor changes, and in one case autonomic involvement, appeared later. Amyloid disease was clinically limited to the peripheral nervous system. In two cases, there was no evidence of familial disease. DNA analysis was performed in these four patients and in two children of Patient 1. Restriction analysis of amplification products of exon 2 of the transthyretin gene was positive for the valine 30 to methionine mutation. These four unrelated patients live in different areas of France. Further studies are needed to determine whether these mutations have a common origin and whether they are related to the Portuguese mutation.

Aged↗