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Biomedical subjects

D Stephens

Publications and source records attributed to D Stephens.

At least 181 records · Page 10Linked to original sources
PubMedDate not supplied

Bilateral simultaneous optic nerve dysfunction after periorbital trauma: recovery of vision in association with with chiropractic spinal manipulation therapy.

OBJECTIVE: To discuss the recovery of optic nerve function after chiropractic spinal manipulation in a patient with loss of vision as a result of facial fracture from a fall. CLINICAL FEATURES: In a fall down a stairwell, a 53-year-old woman with migraines fractured her right zygomatic arch, which was later treated surgically. Approximately 3 weeks after the accident, vision in her contralateral eye became reduced to light perception. Electrophysiologic studies revealed that the function of both optic nerves was diminished, the right significantly more than the left. Single photon emission tomography showed pancerebral ischemic foci. INTERVENTION AND OUTCOME: Chiropractic spinal manipulation was used to aid recovery of vision to normal over a course of 20 treatment sessions. At times, significant improvement in vision occurred immediately after spinal manipulation. Progressive recovery of vision was monitored by serial visual field tests and by electrophysiologic studies. Unfortunately, the patient refused a further single photon emission tomographic study when visual recovery was complete. CONCLUSION: This case report adds to previous accounts of progressive and expeditious recovery of optic nerve function in association with spinal manipulation therapy.

Chiropractic↗
PubMedDate not supplied

Intensive diabetes management decreases Na-Li countertransport in young subjects with type 1 diabetes and enlarged kidneys.

In type 1 diabetes, increases in sodium-lithium countertransport (Na-Li CT), kidney volume (KV), and albumin excretion rate (AER) may precede the development of persistent microalbuminuria. Limited data exist on reversibility of these factors early in the evolution of diabetic nephropathy. A crossover design was used to study the separate effects of enalapril and intensive diabetes management (IDM) on Na-Li CT, KV and AER in 17 children and adolescents with type 1 diabetes (5-10 years duration) with large kidneys (>275 ml/1. 73 m(2)) and predominantly normoalbuminuria. Subjects were randomized to receive 3 months of either enalapril (0.25 mg/kg/day) or IDM, a 3-month washout, followed by the alternate treatment for 3 months. During IDM, HbA1c decreased 2.5% (pre 9.5+/-0.3% (mean+/-SE), post 7.0+/-0.1%, p<0.0001), but was unchanged while on enalapril (pre 8.8+/-0.3%, post 8.5+/-0.3%, p=0.1). A significant decrease in Na-Li CT was seen with IDM (pre 0.43+/-0.05, post 0.36+/-0.04 mmol/l RBC/h, p=0.006) but not angiotensin converting enzyme inhibition (ACE-i) (pre 0.39+/-0.04, post 0.38+/-0.04 mmol/RBC/h, p=0.4). Neither ACE-i nor IDM affected KV or AER. It is concerning that kidney enlargement does not appear reversible at this early stage in the pathogenesis of diabetic nephropathy, although our conclusions are limited by the short duration of intervention and small sample size. The reduction in Na-Li CT with IDM suggests this may be a potentially modifiable risk factor for diabetic nephropathy.

Adolescent↗
PubMedDate not supplied

Efficacy of inhaled tobramycin in the treatment of pulmonary exacerbations in children with cystic fibrosis.

Two forms of treatment of acute pulmonary exacerbations in patients with cystic fibrosis were compared: intravenous ticarcillin (300 mg drug per kg per day) and tobramycin (10 mg drug per kg per day) versus the same intravenous antibiotic therapy plus inhaled tobramycin (80 mg three times per day). The 16 patients in the intravenous plus inhaled tobramycin group were similar to the 12 control patients in age, sex, Schwachman scores, pulmonary function and pretreatment colony counts of Pseudomonas aeruginosa in sputum. Treatment resulted in significant improvement in clinical status and pulmonary function without any apparent differences in the two groups. However, intravenous plus inhaled tobramycin resulted in temporary eradication of P. aeruginosa in 63% of the patients compared to 25% in the intravenous only group (P = 0.03). Suppression of P. aeruginosa in sputum cultures did not correlate with clinical response to treatment. No renal toxicity or elevations of serum tobramycin were observed in the intravenous plus inhaled tobramycin group.

Adolescent↗
PubMedDate not supplied

Application of the Audioscan in the detection of carriers of genetic hearing loss.

The authors describe the establishment of normative stimulus parameters for the Audioscan, an automated sweep frequency audiometer, for its application in the detection of audiometric notches in carriers of recessive genetic hearing loss. A sweep rate of 30 s/octave over the frequency range 300 to 4000 Hz pulsing at 2.5 pulses/s at -5 dB with a step size of 5 dB were ultimately adopted. The criterion for notches was 15 dB or greater within the frequency range 500-3000 Hz. Adopting this criterion, 14.2% of control subjects had notches. Among parents of children with non-syndromal recessive hearing loss 55% were found to have notches. Notches were found more frequently among mothers and sisters than among fathers and brothers of the patients.

Adult↗
PubMedDate not supplied

The use of an open-ended questionnaire to identify positive aspects of acquired hearing loss.

The aim of this study was to identify the kinds of positive experiences associated with acquired hearing loss. An open-ended questionnaire was administered to consecutive patients seen in an audiological rehabilitation clinic. Seventy-nine respondents reported positive experiences encountered as a result of hearing loss. Positive questionnaire responses were grouped to themes corresponding to communicative experiences, psychological experiences, social experiences, and professional and technical support. The most commonly reported positive experiences were reduced disturbance by unwanted sounds (26), successful communication strategies (24), affinity for other hearing-impaired and disabled people (17), perceived self-development (13) and using hearing loss to self-advantage (10). Responses were independent of respondents' audiological and social characteristics.

Adaptation, Psychological↗
PubMedDate not supplied

Analyses of notches in audioscan and DPOAEs in subjects with normal hearing.

In this study, the parameters of notches in the Audioscan have been compared with the distortion product otoacoustic emission (DPOAE) findings in 100 subjects with normal hearing, including 55 normal controls and 45 patients with King Kopetzky syndrome. Of those, 35 subjects had Audioscan notches (11 controls and 24 patients), 96 per cent (53 out of 55 notches) of which were associated with notches in DPOAEs. Analyses showed that the notch centre frequencies obtained in the Audioscan test correlated significantly with those of the notches found on the distortion product audiogram (DP-gram). In addition, the width of notches of the two procedures was also significantly correlated. It is likely, therefore, that such notches on Audioscan and DPOAE testing reflect localized areas of impaired cochlear function.

Adolescent↗
PubMedDate not supplied

Determination of amylose/particulate relationship in hydroxyethylstarch.

Visual particulate was observed to form in parenteral hydroxyethylstarch over 24 months during stability studies. The particulate was identified as being amylose using FT-IR microscopy. Amylose values were measured in the bulk drug using the starch-iodine reaction. The amylose numbers measured in the bulk drug were found to correlate well with the measured particulate values in the parenteral formulation.

Amylose↗
PubMedDate not supplied

Attitudes toward hearing-impaired children in less developed countries: a pilot study.

Various anecdotal reports have been presented about attitudes to hearing loss and deafness in less developed countries but few studies have addressed this matter systematically. In the present study, we have applied a standardised questionnaire to 357 teachers from as uniform a sample as possible within 20 countries in Africa, Latin America, and Asia and compared the results with those obtained from 107 teachers in Western Europe. The questions tapped into their responses toward developing hearing loss themselves, hearing loss in children they encountered. and which group of children with disabilities they would prefer to teach. The geographical origins of the teachers influenced all measures except their view of the contribution that deaf children could make to society. This was influenced solely by the age of the responding teacher.

Adult↗
PubMedDate not supplied

The art and science of medical group turnarounds. Acting in several directions at once, acting at several points in time.

Developing a strategy and turnaround plan for a struggling medical group practice requires a combination of art and science. Orchestrating an effective about-face calls for decisive action on several fronts at once. Too many groups are slow to recognize the need to rescue a perilous situation. And rather than taking immediate action on multiple fronts, they try taking incremental steps over time. Implementing a successful turnaround requires both the diligence of follow-through and the vision to make necessary adjustments throughout the process.

Financial Management↗
PubMedDate not supplied

Hearing aid possession in the population: lessons from a small country.

The results of several studies on hearing aid use in the Welsh population were considered to investigate some general principles on determinants of such use within the general populations of developed countries. Overall hearing aid possession and use were not found to have changed significantly over the past 18 years, remaining at 4 per cent having obtained hearing aids and 3 per cent using them. The possession figures were consistent across all methodologies used. Higher hearing aid use in the post-industrial valleys (in which the traditional industries of coal mining and steel production had disappeared) was explained entirely by a higher level of reported hearing difficulties there. In all populations, less than 20 per cent of those reporting difficulties possessed hearing aids. Whether a hearing aid had been obtained free of charge from the National Health Service or purchased privately did not influence whether it was still used. It was concluded that an effort to improve the acceptability of hearing aids and reduce their stigma is required.

Aged↗
PubMedDate not supplied

Auditory disablements: an update.

In 1999, the World Health Organization issued a document (Beta-2 ICIDH-2) that outlines proposed revisions to the original International Classification of Impairments, Disabilities, and Handicaps. The document, issued for trial purposes, is significant in that it redefines the theoretical context in which audiological research into hearing disability has operated since 1980 and will develop in the future. The purpose of this article is threefold. First, it provides an introductory descriptive overview of the primary disablement dimensions outlined in the Beta-2 version of the ICIDH-2 framework. Second, in discussing the implications of the revised framework for audiology, the article highlights particular classification issues that require clarification if the framework is to be applied effectively in audiological research and practice. Third, the article evaluates the revised framework in the context of recent conceptual developments in audiological research and raises a number of issues for further discussion and investigation. The article concludes that the Beta-2 ICIDH-2 represents a significant advance on the original ICIDH classification framework on three counts. First, much of the rationale underpinning the revised framework, particularly its redefinition of the primary disablement dimensions, is consistent with recent conceptual developments in audiological research into hearing disablements. Second, the framework offers specific pointers for the development of current audiological research and practice. One potential line of enquiry focuses attention on specific ICIDH-2 dimensions that are currently under-represented in audiological literature, namely, the participation and contextual factors dimensions. Another potential line of enquiry focuses attention on issues pertaining to the measurement of function, specifically the inclusion of "positive" outcome indicators in assessment. Finally, the publication of the revised ICIDH-2 framework offers a standard frame of reference from which to conduct larger debates in the audiological literature about the nature and purpose of audiological rehabilitation and the influence of the ecological perspective on the rehabilitative process.

Adaptation, Psychological↗
PubMedDate not supplied

Survey of the perceived benefits and shortcomings of a specialist tinnitus clinic.

Questions about the clinical effectiveness of tinnitus services are of considerable interest to health professionals and health care providers alike in view of the chronic nature of tinnitus, the diversity of tinnitus-related problems, and the range of costs of different approaches to the clinical management of tinnitus. This study sought to identify the views of patients with tinnitus, who attended a specialist tinnitus clinic in Wales, about their satisfaction with that service. One hundred and forty-eight patients returned an open-ended mail-out questionnaire that asked them to list the perceived benefits and shortcomings of attendance at the specialist clinic. The respondents were classified as current or very recent attenders (43 per cent) and those who had first attended between 18 to 60 months earlier (57 per cent). Respondents cited an average of 2.8 benefits compared to only 0.8 perceived shortcomings per respondent. Major areas of perceived benefit included technical assistance, in the form of hearing aid or tinnitus masker fitting, and the general therapeutic nature of the consultation(s) with clinic staff. Statistically significant differences were found in some volunteered benefits in relation to gender and patient status as a current or previous attender. More than one-quarter of the respondents (28.4 per cent) stated that there were no shortcomings to their clinic attendance. The main volunteered shortcoming was lack of treatment effectiveness. The study showed that tinnitus clinic attendance resulted in many of the patients' individually expressed complaints being addressed effectively. Further, the study's findings confirmed the effectiveness of the provision of information and counselling as a fundamental form of tinnitus management for a substantial proportion of patients with tinnitus.

Adult↗
PubMedDate not supplied

Determination and classification of the problems experienced by hearing-impaired elderly people.

The aim of this study was to determine whether participation restrictions and contextual factors could be elicited in an elderly hearing-impaired population using an open-ended questionnaire. The study also tested the value of the World Health Organization's ICF in the classification of the problems experienced by the elderly hearing-impaired. To this end, we administered the 'Life Effects Questionnaire', in which the subjects were asked to list the effects of their hearing loss on their lives. With this approach, significantly more participation restrictions, environmental factors and personal factors were elicited than with a traditional approach. ICF proved useful in classifying these, but the Activity and Participation Scales had a major weakness in terms of non-communication-related hearing problems. Furthermore, a high proportion of the responses came into the personal factors, for which a formal classification does not exist within ICF. This highlights a significant need in that classification.

Activities of Daily Living↗
PubMedDate not supplied

Is there an association between noise exposure and King Kopetzky Syndrome?

The condition in which individuals with normal pure tone audiograms complain of hearing difficulties, especially in the presence of background noise, (normal pure tone audiograms), has had a number of different names. The present term King-Kopetzky Syndrome was coined by Hinchcliffe in 1992. This is a common condition reported in 5 - 10% of those attending clinics complaining of hearing problems. A dominant genetic aetiology has been found in a proportion of cases. It may be associated with minor peripheral or central auditory dysfunction, and frequently the individuals exhibit anxious or depressive personalities. We found no relationship with noise exposure in a series of patients compared with matched controls. Here we review the evidence for and against such an influence and present fresh data in an attempt to define the role of noise, if any, in the causation of this condition. Our final conclusion is that there is no clear association between KKS and noise exposure

Adolescent↗
PubMedDate not supplied

The diversity of case management needs for the care of homeless persons.

Health care providers have been attempting to meet the special needs of homeless people on a national level since 1984. The need to implement strategies specific to serving the diversity of services required by homeless people has been apparent. To devise appropriate strategies, clinical information was drawn from the Health Resources and Services Administration-Health Care for the Homeless (HRSA-HCH) projects, which were created in 1987 primarily to fill such a need. In addition, data gathered by the HCH projects (1984-87) funded by the Robert Wood Johnson and Pew Memorial Trust were used. It is suggested that the past mode of providing health care for the homeless has been found to be inadequate when confronting the complex problems of the homeless person of today. In general, health care providers need to focus more on case management activities, which may include activities not necessarily associated with the provision of health care services (for example, finding and providing food, clothing, shelter, and assessing entitlement eligibility) to achieve the ultimate goal--stabilization--and when possible, reintegration of the homeless person back into society.

Adolescent↗
PubMedDate not supplied

Does 'normal' vision improve with spinal manipulation?

OBJECTIVE: To discuss a patient whose spinal abnormalities may have caused subliminal visual field loss. CLINICAL FEATURES: A 22-yr-old man suffered from a painful neck. His vision was in the normal range, as measured by computerized static perimetry. INTERVENTION AND OUTCOME: To define a guideline for a proposed investigation into visual field changes with spinal adjustment, his visual fields were tested before and after a normal office spinal manipulation. After this procedure, there was a measurable rise in the visual sensitivity of both eyes. CONCLUSION: The use of computerized static perimetry changes to measure the cerebral effects of spinal manipulation is recommended for future chiropractic research.

Adult↗
PubMedDate not supplied

Subclinical vitamin A deficiency: a potentially unrecognized problem in the United States.

Vitamin A deficiency in its subclinical form is a world health problem in young children. The problem is probably under recognized in the United States and other developed countries who do not normally consider their citizens to be malnourished. Lack of a simple screening test to measure subclinical deficiency adds to this problem. Consequently, focused dietary assessment of vitamin A intake by a Food Frequency Questionnaire (FFQ) is a necessary component of health care maintenance, especially for toddlers and preschool age children. Dietary counseling and vitamin supplementation for high risk children is a necessary health promotion intervention.

Adolescent↗