Managing risks in obstetrical nursing.
Explore the source record for details and available documents.
Canada↗
Biomedical subjects
E Phillips
Publications and source records attributed to E Phillips.
Relationship between method of detection of breast cancer and stage of disease, method of treatment, and survival in women aged 40 to 49 years.
The optimal breast cancer screening program for women 40 to 49 years of age remains controversial. To help assess the value of screening mammography for this age group, we studied the relationship between the method of breast cancer detection and stage, therapy, and survival. Cases of breast cancer diagnosed at Sinai Hospital (Detroit, MI) between January 1985 and December 1994 were reviewed. A total of 181 cases involving 40- to 49-year-old women were available for analysis. The distribution of stage of disease significantly differed among the three methods of detection (P<0.0001). Breast-conserving surgery was more commonly performed in cases detected by screening mammography and clinical breast examination than in cases detected by breast self-examination (P = 0.001). Variation in the stage of disease resulted in improved survival for cases detected by screening mammography and clinical breast examination when compared with those detected by breast self-examination (P = 0.019). Women diagnosed with breast cancer between the ages of 40 and 49 years had earlier stage disease, were more likely to be treated with breast-conserving therapy, and had better survival if their disease was first recognized by screening mammography. Screening mammography has an important role for women of this age.
Adult↗
Is there a risk in being a good Samaritan?
It's Nursing Week and you are at a booth in a busy shopping mall. After spending a couple of hours talking with people, answering questions and taking blood pressure readings, you start to sip a well-earned cup of coffee. You glance down the mall and observe a middle-aged man suddenly clutch at his chest and fall to the floor. You alert your colleagues to call 911 as you run down the mall to do what you can. You reach the man, announce, "I know CPR," and initiate resuscitation. You have just spent an invigorating day on the ski slopes. As you drive home, you are horrified to see a car spin out of control and roll over into the ditch a couple of car lengths ahead of you. Suddenly you face a dilemma. You are an experienced nurse who wants to help and yet, lurking in the back of your mind, there is the nagging fear that you could be sued. You wonder if are you legally obligated to stop and assist. Could you be liable if you fail to do so?
Accidents, Traffic↗
Skin reactions associated with bisphosphonates: a report of 3 cases and an approach to management.
Explore the source record for details and available documents.
Adult↗
Determinants of P3 amplitude and response to alcohol in Native American Mission Indians.
Native Americans have some of the highest rates of alcohol abuse and dependence, yet potential biological risk factors associated with the problem drinking seen in some tribes remain relatively unknown. The amplitude of the P3 component of the event-related potential (ERP) is perhaps the most studied electrophysiological "marker" of potential vulnerability to alcohol dependence, yet it has not been investigated in Native Americans. Forty-seven, non-alcohol-dependent Native American Mission Indian men between the ages of 18 and 25 years participated in the study. ERPs were collected at 60 minutes following both alcohol (0.56 g/kg) and placebo intake. No relationship was found between P3 amplitude and degree of Native-American heritage (NAH), or family history (FH) of alcohol dependence. The results of this study did, however, replicate previous findings that the P3 component of the ERP is sensitive to the effects of alcohol. A reduction in the P3a component across the scalp was found in these Native American men following alcohol when compared with placebo ingestion. P3 response to alcohol, although not influenced by a subject's NAH or FH, was influenced by the presence of a polymorphism in the alcohol metabolizing enzyme alcohol dehydrogenase (ADH). Men with an ADH2 x 3 allele had significantly higher amplitude P3 components at placebo and also demonstrated more alcohol-induced reductions in P3 amplitude than men with ADH2 x 1 alleles only. In addition, individuals with low P3 amplitude in the placebo condition had less of a reduction or an actual increase in P3a and P3b amplitudes following alcohol intake. Given that a less intense response to alcohol has been associated with greater risk for the development of alcohol-related problems, these data suggest the presence of certain biological variables within this Native American population that may confer both risk and protection for the future development of alcohol dependence.
Acoustic Stimulation↗
Allelic imbalance at chromosomal loci implicated in the pathogenesis of oral precancer, cumulative loss and its relationship with progression to cancer.
A microsatellite assay was used to screen 31 potentially malignant oral lesions presenting as leukoplakia and erythroplakia, with histological evidence of dysplasia, for genetic abnormalities at loci which frequently show allelic imbalance when oral squamous cell carcinomas (SCC) are examined. The microsatellite and restriction fragment length polymorphism (RFLP) markers selected were at 3p21, 8p21-23, 9p21 and included sequences within the Rb (13q14.2), p53 (17p13.1) and DCC (18q21.1) tumour suppressor genes. 8 patients subsequently developed an invasive tumour at the same site, or within 2 cm of the premalignant lesion. A further 8 patients developed SCC at a distant site. Seventy-seven per cent (24/31) of these potentially malignant lesions showed allelic imbalance (AI) and 55% (17/31) of cases showed microsatellite instability (msi). The probability of developing SCC was much greater for patients with lesions showing AI at two or more relevant loci (P = 0.008 by the logrank test) than the group with AI at fewer loci. The estimated probability of development of SCC in this group by 5 years was 73% (95% Cl: 50-92%). This suggests that determining the number of genetic abnormalities in a potentially malignant lesion can help identify patients with true precancers who should be followed closely to ensure that they receive chemoprevention and appropriate advice to limit risk factors, and to allow the early detection of invasive lesions.
Adult↗
Spinal neurokinin NK1 receptor down-regulation and antinociception: effects of spinal NK1 receptor antisense oligonucleotides and NK1 receptor occupancy.
To define the effects of antisense oligonucleotides on spinal neurokinin 1 (NK1) receptor function in nociceptive processing, several antisense oligonucleotides directed against the NK1 receptor mRNA were intrathecally injected into rats via an implanted catheter, and their effect on the behavioural response to formalin injected into the paw was assessed. We observed that there was no significant reduction of pain behaviour or immunostaining of spinal NK1 receptors after repeated daily intrathecal treatment with an antisense oligonucleotide. However, spinal application of substance P (SP) in the antisense oligonucleotide-treated animals resulted in a profound and long-lasting reduction in the behavioural response to formalin injection, and a parallel reduction in the NK1 receptor immunoreactivity normally observed in spinal dorsal horn. Intrathecal SP in the control groups, i.e., rats treated with an oligonucleotide containing four mismatched bases, the corresponding sense oligonucleotide, a mixture of the sense and the antisense oligonucleotides, in each case had no effect. The effects of SP were blocked by NK1 receptor antagonists and were not mimicked by NMDA. The mechanism underlying these effects is not clear. It may be due to partial degradation of the internalised receptors, which cannot be replaced by newly synthesised receptors because of the action of the NK1 antisense oligonucleotide.
Animals↗
A prospective controlled multicentre study of clarithromycin in pregnancy.
Clarithromycin is a relatively new macrolide antibiotic with an action spectrum similar to that of erythromycin. Its main indications for use are for upper and lower respiratory and skin and soft tissue infections. Little is known about its safety in pregnancy, although animal reproductive studies found an increased rate of cardiovascular anomalies, cleft palate, and embryonic loss. Human data, limited to case reports and one small uncontrolled study, cannot allow evidence based counseling of pregnant women who were exposed to the drug before finding out they were pregnant. Pregnant women who had been counseled on the use of clarithromycin by five centers, were matched for age, smoking, and alcohol use with a control group of pregnant women who were exposed to nonteratogenic antibiotics. A total of 157 women were followed up. Of these, 122 were exposed to the drug in the first trimester. There were no significant differences found between the two groups in the rates of major and minor malformations; 2.3 versus 1.4% for major (p = 0.86) and 5.4 versus 4.9% for minor (p = 0.96). Spontaneous abortion rates in the exposed group was significantly different, higher (14%) than in the control group (7%) (p = 0.04). This first prospective controlled study of exposure to clarithromycin in pregnancy suggests that this agent does not increase the rate of major malformations above the baseline risk of 1-3%. The higher rate of reported spontaneous abortions, although still within the expected baseline rate, may warrant further study.
Anti-Bacterial Agents↗
Toxoplasmosis.
QUESTION: A 28-year-old patient is 3 months pregnant with her first child. She has heard about toxoplasmosis from her friends and asks if it is safe to keep her cat. How should I reply? ANSWER: Your patient does not have to give up her cat. She should be encouraged to take primary preventive measures. If toxoplasmosis serology is performed, a baseline should be done as early as possible with serial follow up in the second and third trimesters.
Adult↗
Field cancerisation of the oral cavity: comparison of the spectrum of molecular alterations in cases presenting with both dysplastic and malignant lesions.
Dysplastic lesions and invasive oral squamous cell carcinoma (SCC) from patients with field change were screened by restriction fragment length polymorphism (RFLP) and microsatellite assay. All tumours contained more genetic changes than the matched dysplasia which are likely to represent progression. Four of the 15 dysplastic lesions harboured the same abnormalities detected in the tumour and some paired lesions showed identical novel microsatellite alleles. The finding of identical 'genetic fingerprints' in dysplastic lesions and invasive carcinoma from the same patient provides strong evidence that these dysplasias are precursor lesions and that multiple lesions have probably arisen due to transfer of the progeny of an altered cell. Eight of the 15 dysplastic lesions showed alterations which were not present in the matched cancer, showing that evolution of subclones, or fusion of multiple clones also occurs. A further case showed loss of different alleles in the paired samples. These findings highlight the complexity of the genetic abnormalities present in the mucosa of patients with field change and suggests that the origin of these altered foci may be diverse.
Adult↗
Negative symptoms in stroke patients and length of hospital stay.
The purpose of this study was to assess whether the presence and severity of psychiatric symptoms in stroke patients correlate with their length of stay (LOS) in a rehabilitation unit, with special emphasis on the role of negative symptoms (NS). Twenty-three stroke patients, consecutively recruited from the inpatient rehabilitation unit, were evaluated on admission with the Mini-Mental State Examination (MMSE), the Positive and Negative Symptom Scale (PANSS), the Hamilton Depression Rating Scale (HDRS), the Scale for Assessment of Negative Symptoms (SANS), and the Functional Independent Measure (FIM). NS scores significantly correlated with LOS, with SANS total score being the most informative, and the attentional impairment subscale the least. The group of patients with pronounced NS stayed in the hospital twice as long as patients with the score on the NS subscale of PANSS below 16. These two groups did not differ in their cognitive performance or in the positive symptom subscale of PANSS scores. Total FIM score on admission was lower and HDRS scores higher in patients with pronounced NS. However, these differences, unlike those of LOS, have not reached statistical significance. The presence and severity of NS in stroke patients are associated with a longer hospital stay. Identification and treatment of NS might lead to a faster discharge from rehabilitation unit.
Aged↗
Characterization of a recombinant fragment that contains a carbohydrate recognition domain of the filamentous hemagglutinin.
The filamentous hemagglutinin (FHA) of Bordetella pertussis plays an important role in establishing infection by attaching the bacteria to the ciliated respiratory epithelial cells. Expression of DNA encoding residues 1141 to 1279 of FHA in Escherichia coli yields a protein of 18,000 Da that exhibits some of the carbohydrate recognition properties of FHA (S. M. Prasad, Y. Yin, E. Rodzinski, E. I. Tuomanen, and H. R. Masure, Infect. Immun. 61:2780-2785, 1993). We have constructed an E. coli strain that expresses this protein, designated fragment A, in a soluble form at markedly elevated levels. Fragment A could be purified with high purity and yields and was immunogenic in mice. Both fragment A and anti-fragment A sera inhibited the binding of B. pertussis to asialo-GM2 and to rabbit ciliated cells. These observations demonstrate that this fragment of FHA contains a cellular binding domain capable of eliciting functional antibodies.
Adhesins, Bacterial↗
Electrophysiological findings during the menstrual cycle in women with and without late luteal phase dysphoric disorder: relationship to risk for alcoholism?
This study evaluated electrophysiological (EEG, ERGs), and cognitive (neuropsychological testing) responses in patients with late luteal phase dysphoric disorder (LLPDD, DSM-III-R) and controls over the menstrual cycle. In both groups, the frequency and stability of electroencephalogram (EEG) alpha activity significantly differed over the menstrual cycle. The latency of the P3 components of the auditory event-related potentials (ERPs) did not vary as a function of the menstrual cycle, but the P3 latency was found to be later in LLPDD subjects as a group. When the LLPDD subjects were assessed based on family history of alcoholism, it was found that those with alcoholic relatives had more high-frequency alpha (9-12 Hz) in their EEG, lower P3 component amplitudes, and longer P3 component latencies when compared to LLPDD subjects without alcoholic relatives or controls. These data suggest that LLPDD may have persistent neurophysiological correlates, some of which are also in common with risk for alcoholism.
Adult↗
Effect of patient position upon success in placing central venous catheters.
BACKGROUND: There is little consensus regarding the most efficient or the safest method by which to place a central venous catheter (CVC). METHODS: A single house officer prospectively evaluated 140 patients for whom he was requested to place CVCs. One hundred and eight patients participated in a randomized study of positioning. Of the 140 patients, 7 had emergency line placement; 105 randomized patients undergoing elective CVC placement form the basis for this report (power > 80% to detect change of one needle pass between groups). Patient positions were termed "bump" (head turned to the contralateral side and a rolled towel placed vertically between the scapulas) and "no bump" (head facing forward and no towel placed in the back.) RESULTS: Ninety-three of 105 patients had successful catheter placement. Catheters were more often successfully introduced in the bump group than no bump group (98% versus 83%, P < 0.04). For patients with difficult CVC placement (those > 160 pounds, those with a weight-to-height ratio > 29, those with previous unsuccessful catheterization), the bump position was superior with respect to increased likelihood of venous blood return, decreased likelihood of arterial blood return, and increased likelihood of successful catheterization, although differences did not reach statistical significance (P < 0.05) in individual analyses. Of patients with successful catheterization, 97% had three or fewer needle passes. Those with more than three needle passes were less likely to have successful catheter placement (P < 0.01), were more likely to have arterial blood return (P < 0.01) and pneumothorax (P = 0.12). CONCLUSIONS: The bump position improves the likelihood of successful central venous catheter placement. No more than three needle passes ought to be attempted.
Aged↗
A method of closing laparoscopy port incisions using a modified Veress needle.
A new method of closing laparoscopy port incisions uses a modified Veress needle. The device easily closes the fascia and peritoneum, which should prevent incisional hernias at these sites. It adds little if any cost to laparoscopic procedures. It has been used in 28 patients with satisfactory results.
Humans↗
Personality traits in LLPDD and normal controls during follicular and luteal menstrual-cycle phases.
In 15 women with Late Luteal Phase Dysphoric Disorder (LLPDD) and in 15 normal control subjects, personality traits were assessed using the Millon Clinical Multiaxial Inventory (MCMI) during follicular and luteal menstrual-cycle phases. Compared with controls, LLPDD subjects had less compulsive but more passive/aggressive and borderline/cycloid traits, and more depression and hypomania. Menstrual-cycle phase did not significantly affect personality variables in either group. In particular, depression and hypomania in LLPDD subjects suggests a relationship with affective disorders.
Adult↗