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Biomedical subjects

D Harrell

Publications and source records attributed to D Harrell.

9 recordsLinked to original sources
PubMed2007

Pseudoaneurysm of the inferior gluteal artery: an unusual complication after abdominoperineal resection for rectal cancer. Report of a case.

We report an unusual case of profuse, sporadic hemorrhage from a chronically infected perineal wound after an abdominoperineal resection. Surgical exploration and angiography on two occasions failed to identify the source of bleeding. A pseudoaneurysm of the internal iliac artery was eventually identified with a provocative angiogram using tissue plasminogen activator. This aneurysm was successfully treated with embolization with coils.

Aneurysm, False↗
PubMed2000

An autonomy supportive model of geriatric team function.

Interdisciplinary teams play a critical role in the delivery of geriatric health care. Health care professionals are commonly left to develop teamwork skills by chance. Medical team function differs from traditional group theory in that all members are caregivers. A non-competitive supportive atmosphere is appropriate for patient care. We propose a participatory (autonomy supportive) model fostering self-realization and positive reinforcement as an organizing philosophy. The primary group task is to maximize patient functional independence and personal goals. Leadership is task-dependent.

Aged↗
PubMed1996

The evolution of the school nurse practitioner: past, present, and future.

The role of school nurse practitioner (SNP) evolved in response to the growing need of the school-age population for health care and the school as a setting for providing primary health services. SNPs have broadened the role of the traditional school nurse while extending advanced nursing into the arena of primary health services.

History, 20th Century↗
PubMed1994

Effectiveness of an inpatient geriatric service in a university hospital.

OBJECTIVE: To assess the effectiveness of an acute interdisciplinary inpatient geriatric service in a university hospital. DESIGN: Prospective randomized control study. SETTING: Large urban university hospital. PATIENTS: 40 consecutive inpatients, randomized for inclusion on the geriatric service (study patients, n = 20) or to continue usual hospital care (control patients, n = 20) from among the geriatric consult population. MAIN OUTCOME MEASURES: Subjects were followed for changes in length of stay, hospital costs, diagnostic testing, pharmacy use, functional status, discharge disposition, and readmission within 30 days after hospitalization. RESULTS: Mean age of patients study 79.2 years (control 73.9 years). Sixty percent of study patients went home and 30% to nursing homes (control 20% home, 65% nursing homes) P = .03. Total length of stay mean 20.3 days study (control 32.7 days), length of stay after randomization mean 7.7 days study (control 11.2 days), mean overall hospital costs $23,906 study (control $45,189), and mean hospital costs after randomization study $4,671 (control $9,404) were not significantly different by F-tests due to wide variability. Laboratory use was reduced with mean 4.4 tests study (control 16.9) P = .01 and mean laboratory costs $263 study (control $828) P = .02. Functional ability improved (scale 1-7) with mean improvement study 0.8 (control 0.3) P = .09. Mean number of medications were lower in the study group by 30% P = .02; mean cost of medications at discharge was reduced with study $38 (control $112); and mean pharmacy charges after randomization decreased $462 study (control $1,268) P = .06. Readmission 30 days after discharge was not significantly different (study 21%, control 33%). CONCLUSIONS: An interdisciplinary acute geriatric service can be cost effective in providing care to elderly patients in a university hospital. It can improve outcomes measured by decreased laboratory and pharmacy usage, improved functional status, and discharge to a lesser level of care without increasing length of stay or early readmission after discharge.

Aged↗
PubMed1988

Binding of tissue-specific factors to the enhancer sequence of hepatitis B virus.

We have identified tissue-specific factors, in human hepatoma cells, that bind specifically to the transcriptional enhancer sequence of the human hepatitis B virus (HBV). Two different types of protein factor were found in nuclear extracts of hepatoma cells by gel mobility shift assay. One factor was observed in human hepatoma cells but not in human kidney, lung, or vein cells, or in embryonic mouse cells. The other was discovered in both human hepatoma cells and human vein cells. DNase I footprint analysis, using the enhancer fragment (164 bp, AccI-SphI) from HBV, revealed that two specific sites are recognized by the nuclear factors. These sites contain consensus octamer sequences which have been found in many other enhancer elements. These results strongly suggest that the two nuclear factors found in hepatoma cells play key roles in the function of the HBV enhancer.

Animals↗
PubMed1979

The evaluation of the periotron.

These preliminary investigations seem to indicate that the periotron may be useful in assessment of the presence of gingival inflammation in the clinical periodontal pockets. Successive recordings of the same volume varied from 5 to 11%. Data from the periotron showed a high correlation with increased known volumes of fluid and with assessment of gingival inflammation using the GI. Assessment with the periotron varied with the dissipation constant of fluids. Since the dissipation constant of gingival fluid varied among individuals, this constant must be evaluated when the instrument is used in clinical and research efforts.

Animals↗