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Biomedical subjects

D Walk

Publications and source records attributed to D Walk.

At least 19 recordsLinked to original sources
PubMed2003

Late occurrence of chronic immune-mediated axonal polyneuropathy following bone marrow transplant for juvenile-onset alpha-mannosidosis.

A 23-year-old woman with juvenile-onset alpha-mannosidosis developed an axonal polyneuropathy more than a year following successful unrelated donor (URD) BMT complicated by chronic graft-versus-host disease (GVHD). Progressive muscle weakness and paresthesias developed over at least 4 months, and made her nonambulatory. Nerve conduction and EMG studies demonstrated an axonal sensorimotor neuropathy. Cerebral spinal fluid (CSF) IgG was elevated with two peaks not identified in serum. Strength improved after a single course of plasma exchange and continued to improve over 12 months. The response to plasma exchange, elevated CSF IgG production, and evidence of a serum IgM peak suggest an immune-mediated mechanism. Chronic polyneuropathies following BMT are rare and are usually temporally related to GVHD or infection. This patient's disease was unusual because of its late occurrence and chronic onset in the face of resolved GVHD and in the absence of infection.

Adult↗
PubMed1999

Functional improvement of elderly residents of institutions.

Studies have shown that some elderly persons who suffer decline in activities of daily living (ADL) functioning experience an improvement. This phenomenon has been examined mainly among elderly persons in the community using summary ADL indices. This article examines functional improvement among 2,527 residents of institutions for semi-independent and frail elders in Israel in four specific ADLs--bathing, eating, bladder continence, and mobility--at two points in time, 2 to 4 years apart. Demographic, functional, and institutional variables were used to predict functional improvement through logistic regression. The variables were found to differentially affect each ADL, highlighting two opposite aspects of institutionalization--deterioration, on the one hand, and rehabilitation through intervention by highly trained staff, on the other.

Activities of Daily Living↗
PubMed1999

Institutions for the elderly operating without a license: quality of care and the surveillance process.

In 1992, Israel's Services for the Aged identified private institutions for the elderly operating illegally, which are notorious for poor quality. This article presents the findings of screening visits in 97 "pirate" institutions, as part of a plan to improve surveillance, and evaluates the outcomes as a measure of the effectiveness of intervention. Although a high proportion of deficiencies was found, some institutions showed a significant ability to correct them.

Aged↗
PubMed1998

Mononeuropathy multiplex due to infiltration of lymphoma in hematologic remission.

We report a case of progressive mononeuropathy multiplex in a patient with lymphoma in hematologic remission. At the time of presentation there was no evidence of meningeal or central nervous system metastasis. At autopsy, extensive infiltration of tumor cells was found in both femoral nerves. We review the literature pertaining to multifocal malignant lymphoid infiltration of peripheral nerves, which can occur during hematologic remission or in the absence of any evidence of systemic lymphoma.

Fatal Outcome↗
PubMed1996

Licensing, quality of care and the surveillance process.

As part of the evaluation of an experimental programme of surveillance of institutions for the semi-independent and frail elderly using the regulation, assessment, follow-up (RAF) method, an examination was made of the licensing status, quality of care, and completeness of the surveillance process. Included in the examination were 126 institutions which underwent the surveillance process between 1990 and 1993. Aims to investigate whether the RAF method of surveillance was being implemented in a professional and uniform manner. Concludes that surveyor's recommendations to grant or not grant a licence were usually based on findings about the quality of care. Nevertheless, in order to reinforce the relationship between licensing and quality of care, it was suggested that surveyors be given clear criteria of quality on which to base their recommendations regarding conditional licensing. It was found that the surveillance process is indeed implemented uniformly in long-term care institutions of varying quality.

Accreditation↗
PubMed1996

Two-unit reliability analysis of questionnaires used in a regulatory system.

An interjudge reliability test was conducted to evaluate the questionnaires used in the surveillance of residential care institutions. Because the reliability test was carried out as part of the routine surveillance program and not as part of a controlled experiment, it was subject to deviations from the optimal reliability test model. However, this nonpure design provided an opportunity to not only examine the reliability of the items in the surveillance tool, but also to gain a better understanding of the use of a reliability test in an "imperfect" field setting. Two different surveyor teams administered the 257 questions on the questionnaires to a representative sample of 32 institutions on two separate occasions. In order to explain the variance in the reliability scores, a multivariate analysis was conducted for two units of analysis: the surveillance questions and the institutions. Based on the results of the reliability test, changes were introduced to improve the questionnaires and their administration.

Aged↗
PubMed1995

Characteristics of motor unit discharge in subjects with hemiparesis.

We studied the discharge rates and recruitment characteristics of single motor units in paretic and contralateral arm muscles of 6 hemiparetic subjects. Motor unit activity in biceps brachii was recorded at different elbow torques, and the activity related both to the mean level of surface electromyographic activity, and to the degree of weakness. In 3 of the 6 subjects, there were significant reductions in mean discharge rate of motor units in the paretic muscle. All 6 subjects showed compression of the range of motoneuron recruitment forces, and a failure to increase motor unit discharge rate during voluntary force increases in paretic muscles. These rate reductions could potentially alter the precise match of motoneuron properties to the mechanical properties of the innervated muscle fibers, and reduce the efficiency of muscle contraction. This reduction could lead, in turn to increased effort, to fatigue, and ultimately to a sense of weakness for voluntary force generation.

Adult↗
PubMed1994

Improving regulation of care.

The JDC-Brookdale Institute of Gerontology, in collaboration with Israel's Ministry of Labor and Social Affairs and Ministry of Health, has developed a program to improve government regulation of long-term care institutions for the elderly, and thus the quality of institutional care. The aim of the program was to introduce greater uniformity and objectivity into the existing surveillance system, increase the participation of institution residents, and ensure public access to instruments and criteria. The tracer methodology was used and tracers representing the medical, nursing, psychosocial and environmental-operational areas were developed in consultation with specialists in each field. The program was welcomed by surveillance personnel, and implemented on a nation-wide basis. Although there have been difficulties with its implementation, these have largely been resolved through discussion, workshops and supplementary training for surveyors. Due to the program's success, new programs are being developed to improve the regulation of other kinds of institution.

Aged↗
PubMed1992

Somatosensory evoked potentials in the evaluation of lumbosacral radiculopathy.

We performed lower extremity somatosensory evoked potential (SEP) studies in 59 patients with signs or symptoms suggestive of lumbosacral radiculopathy and compared them with results of myelography with post-myelogram CT (myelogram/CT), MRI, and other electrodiagnostic studies. Of 38 patients with abnormal myelogram/CTs, 32 had abnormal SEPs, while 11 demonstrated EMG abnormalities. All 21 patients with normal myelogram/CTs had normal SEPs. SEP improved electrodiagnostic sensitivity in patients with weakness or reflex changes as well as in those with sensory deficits only. SEP was less sensitive in patients in whom spinal stenosis was the only radiographic finding. MRI generally corresponded well with the results of myelogram/CT and SEP but overestimated the significance of disk bulges in some patients. SEP is useful in the electrodiagnostic evaluation of lumbosacral radiculopathy, particularly when EMG is nondiagnostic.

Back Pain↗
PubMed1988

Factors influencing non-attendance at child psychiatry out-patient appointments.

The clinic attendance of 100 consecutive referrals to child psychiatry is described. Only 47 cases ended in agreed discharge. Different factors were found to be associated with attrition at different stages in the treatment-uptake process. Of referrals offered an appointment, 16% failed to attend at all; this was significantly associated with parents being against referral. Of cases offered a subsequent appointment, 40% dropped out. Continued attendance was associated with a presenting problem of general anxiety and with consultation to the referrer. Dropping out was associated with parents who were separated.

Adolescent↗