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Biomedical subjects

G Sherwood

Publications and source records attributed to G Sherwood.

At least 19 recordsLinked to original sources

Qualitative assessment of hospitalized patients' satisfaction with pain management.

Patient evaluations of effectiveness of care and satisfaction with care are useful outcome indicators of pain management. The subiective, multidimensional nature of pain is best evaluated when outcome measures include the richness of qualitative data to more fully capture the range of patient experiences. A descriptive qualitative component was added to the American Pain Society Patient Outcome Questionnaire--Modified (1995) to determine critical indicators in the pain experience affecting patient satisfaction. Four themes emerged from the data as factors affecting patient satisfaction or dissatisfaction: Patient Pain Experience, Patient Views of Health Care Providers, Patient Pain Management Experiences, and Pain Management Outcomes. The result is a typology of factors affecting patient reports of satisfaction. Satisfaction was most likely when providers effectively addressed pain control with the patient as an informed partner. Patients expressed dissatisfaction, even when pain was relieved, when providers appeared uncaring, were slow to respond, or lacked knowledge and skill. Our results offer clinicians new insights into how patients respond to pain, which could enable development of patient-oriented approaches to pain management improving quality and effectiveness of care and increasing patient satisfaction.

Adolescent↗

Development of a pain management report card for an acute care setting.

The article describes a pain management report card developed as a result of a study on pain satisfaction. The report card presented the actual results of the study and compared them with the institution's predetermined goals. Comparison items included adherence to national pain guidelines for pain management, various measures of the pain experience, and satisfaction with nurse and physician caregivers related to pain management. Recommendations were made to the institution based on the findings.

Acute Disease↗

An ethnographic assessment of an academic nursing center.

Establishment of nursing centers is one of the most important and most exciting trends in the profession of nursing. Nurse practitioners have been taking the lead in the management and staffing of nursing centers. The purpose of this study was to provide a description and an analysis of an academic nursing center. Through a series of observations and interviews, an interdisciplinary team investigated the history and organizational development of the center; the everyday delivery of services; staffing; and participants' assessment of the efficiency and quality of its services and recommendations for improving the services provided in the examined nursing center.

Anthropology, Cultural↗

Clinical course of cognitive dysfunction in systemic lupus erythematosus.

OBJECTIVE: To prospectively evaluate changes in cognitive function in a cohort of unselected patients with systemic lupus erythematosus (SLE) and controls over a 12 month period. METHODS: Seventy female patients with SLE, 25 patients with rheumatoid arthritis (RA) and 23 healthy subjects (age and sex matched) were evaluated using the Wechsler Adult Intelligence Scale-Revised (WAIS-R), the Wechsler Memory Scale-Revised (WMS-R), the California Verbal Learning Test (CVLT) and the National Adult Reading Test-Revised to identify impairment in 8 areas of cognitive function. Cumulative disease manifestations and current medications were documented, and disease activity was expressed using the SLE disease activity index (SLEDAI). Decision rules were determined for overall cognitive impairment. RESULTS: At baseline, 21% (15/70) of patients with SLE were impaired compared to 4% (1/25) of patients with RA and 4% (1/23) of healthy subjects (p = 0.042). After a mean interval of 12.8 months (range: 11-17) 84% (59/70) of patients with SLE, 44% (11/25) of patients with RA and 80% (17/23) of healthy subjects were reassessed. This included all subjects who were impaired at the initial assessment. Using the same decision rules as at baseline, 12% (7/59) of patients with SLE were impaired at followup compared to none of the patients with RA and healthy subjects. Over the period of study cognitive impairment persisted in 3 patients with SLE, resolved in 12 and evolved in 4 others. There was no apparent association between changes in cognitive function and concurrent changes in generalized disease activity, overt neuropsychiatric disease or corticosteroid medication. CONCLUSION: Our results suggest that cognitive dysfunction in patients with SLE is evanescent, does not necessarily lead to irreversible neurologic compromise and changes independently of other clinical variables.

Adult↗

Educational outreach in a rural underserved area.

A school of nursing in a world-renowned urban medical center joined forces with a school of nursing in a rural, underserved, ethnic minority area 350 miles distant. By working together, the two schools of nursing re-energized professional nursing in a geographically remote area of Texas. This underserved region is the fastest growing area in the state; education and health care resources have not kept pace with demand. Consequently, nursing faculty recruitment lagged, two few nurses had advanced practice skills, and morale suffered because of nursing staff and faculty shortages. Leadership in the two schools forged an educational and political partnership to create a collaborative model to meet the higher education needs of this area of southwest Texas. By detailing the eight steps of a unique success story, the article offers a model for meeting the evolving health care and nursing education needs of the '90's.

Humans↗

Cognitive impairment and autoantibodies in systemic lupus erythematosus.

Nervous system involvement in systemic lupus erythematosus (SLE) includes a wide array of manifestations some of which have been associated with specific autoantibodies. These include reactivity to surface neuronal and lymphocyte antigens, ribosomal P and cardiolipin. The aim of the present study was to examine the association between cognitive abnormalities and these autoantibodies in an unselected female population of SLE patients. Using a battery of standardized neuropsychological tests, cognitive impairment was identified in 15/70 (21%) SLE patients compared to 1/25 (4%) patients with rheumatoid arthritis and 1/23 (4%) healthy subjects (P = 0.04). Circulating antineuronal antibodies were measured by indirect immunofluorescence using human neuroblastoma cell lines IMR-6 and SK-N-SH. Lymphocytotoxic antibodies were measured by microcytotoxicity. Antibodies to ribosomal P and cardiolipin were measured by ELISA. Antineuronal antibodies were detected in 34%, lymphocytotoxic antibodies in 47%, anti-P antibodies in 17% and anticardiolipin antibodies in 24% of patients. In the cognitively impaired and unimpaired SLE patients there was no significant difference in the prevalence of antineuronal antibodies (33 vs 35%), lymphocytotoxic antibodies (40 vs 50%), anti-P antibodies (20 vs 17%) or anticardiolipin antibodies (7 vs 29%). The titre and isotype of autoantibodies were also similar in both groups. These results suggest that autoantibodies which have previously been associated with nervous system manifestations of SLE are not likely to be directly involved in the pathogenesis of cognitive dysfunction.

Antibodies, Anticardiolipin↗

Patterns of cognitive impairment in patients with systemic lupus erythematosus.

This study examined neuropsychological test performance in a representative sample of 70 female patients with SLE. The influence of current or past clinically overt central nervous system involvement, use of corticosteroid medications and overall disease activity were evaluated. The results suggest two distinct patterns of cognitive dysfunction. Impaired delayed recognition memory was associated with past or current nervous system involvement, suggesting the presence of a residual neurologic deficit. Increased disease activity was associated with impaired immediate memory and concentration which may represent transient and diffuse central nervous system effects. Although corticosteroid use was associated with poor word list recall, group differences were not statistically significant when disease activity was considered as a covariate in the analysis. Follow-up studies are required to determine if these abnormalities persist or fluctuate with changes in disease activity and concurrent medications.

Adrenal Cortex Hormones↗

Cognitive impairment in patients with systemic lupus erythematosus.

Seventy unselected patients with systemic lupus erythematosus (SLE) were studied to determine the prevalence of cognitive impairment and the association with other clinical variables. Twenty-five patients with rheumatoid arthritis (RA) and 23 healthy subjects were used as controls. All patients were evaluated with a battery of standardized neuropsychological tests to determine ability in 8 areas of cognitive function. Clinically overt neuropsychiatric (NP) SLE, cumulative disease manifestations and concurrent medications were documented. In patients with SLE, generalized disease activity was expressed using the SLE disease activity index. Cognitive impairment was identified in 15/70 (21%) patients with SLE, 1/25 (4%) patients with RA and in 1/23 (4%) healthy subjects (p = 0.042). The prevalence was higher in patients with active NP-SLE at the time of assessment (2/5, 40%) compared to patients with inactive NP-SLE (2/10, 20%) but was also increased in those patients who had never had known clinical NP-SLE (11/55, 20%). A history of serositis (p = 0.015), active SLE (p = 0.064) and corticosteroid use (p = 0.027) at the time of assessment were more common in patients with cognitive impairment. The results suggest that cognitive impairment is increased in patients with SLE. It may occur independently of clinically overt NP-SLE and is more common in patients with active disease who are receiving corticosteroids.

Adult↗

Iron overload complicating sideroblastic anemia--is the gene for hemochromatosis responsible?

Idiopathic hemochromatosis is a hereditary disease that is associated with human leucocytic antigens A3, B7, and B14. A genetic association between human leucocytic antigen-linked hemochromatosis and idiopathic refractory sideroblastic anemia has been suggested that may predispose some patients with idiopathic refractory sideroblastic anemia to develop gross iron overload. Study of the family of a patient with idiopathic refractory sideroblastic anemia and hemochromatosis revealed that 2 of 5 first-degree relatives had significant elevations of serum ferritin, and a shared human leucocytic antigen haplotype, supporting the concept that patients with idiopathic refractory sideroblastic anemia and significant iron overload have at least one allele for hemochromatosis.

Aged↗

Rhizomelic chondrodysplasia punctata: clinical, pathologic, and biochemical findings in two patients.

The clinical, pathologic, and biochemical features of rhizomelic chondrodysplasia punctata are described in two patients. Although both patients had clinical and radiologic similarities, one patient survived for only 13 days and the other is still alive at 8 years. The most prominent pathologic feature was the marked degenerative change in the chondrocytes from resting cartilage. Fibroblast alkyldihydroxyacetone phosphate synthase activity was markedly reduced in both patients (approximately 10% of control mean); in contrast, dihydroxyacetone phosphate acyltransferase activity was only moderately reduced (50% of control mean). Alkyl and alk-l-enyl ether (plasmalogens) levels were very low in brain and liver. The accumulation of phytanic acid observed in plasma or liver was paralleled by a reduced ability of the patients' fibroblasts to oxidize phytanic acid. Our data indicate that the genetic defect in rhizomelic chondrodysplasia punctata results in abnormalities in two apparently unrelated pathways (i.e., phytanic acid oxidation and ether lipid biosynthesis.

Brain↗

Clinical presentation of mitochondrial respiratory chain defects in NADH-coenzyme Q reductase and cytochrome oxidase: clues to pathogenesis of Leigh disease.

Measurement of pyruvate and lactate produced from glucose by confluent skin fibroblast cultures from 95 patients with lactic acidemia revealed 10 in whom the lactate/pyruvate ratio (L/P) was increased (L/P = 57 to 232) compared with that observed in control cell lines (L/P = 18 to 35). Mitochondria prepared from these cells revealed two types of respiratory chain defect. In four patients the deficient activity was present in NADH-coenzyme Q reductase (14% to 21% of controls), and in six the deficiency was in cytochrome c oxidase (21% to 28% of controls). The four patients with NADH-coQ reductase deficiency presented early with lactic acidosis, respiratory failure, anorexia, and hypotonia; all four died within 7 months. The group with cytochrome oxidase deficiency had a somewhat later (18 months to 2 years of age) presentation with milder lactic acidemia, but also with hypotonia and anorexia. They had delayed development, beginning to walk and talk at 18 to 24 months, and then slowly regressed. Although an investigation of central nervous system disorders in this latter group has not been possible, the clinical progression fits into the broad category of Leigh disease. We conclude that in these two groups respiratory chain defects can be detected and localized by the use of skin fibroblast cultures.

Brain Diseases, Metabolic↗

Growth and development in patients operated on for islet cell dysplasia.

Neonatal hypoglycemia caused by islet cell dysplasia (ICD), sometimes called nesidioblastosis, may lead to psychomotor retardation and neurologic dysfunction in up to 50% of patients who are not given early aggressive treatment. In 1979, we adopted a more aggressive protocol for treating this condition that consists of the following steps: immediate insertion of a silastic central venous line for reliable venous access; continuous intravenous infusion of glucose and glucagon to maintain euglycemia; oral diazoxide; and near total pancreatectomy if the first steps fail to overcome the hypoglycemia or the patient cannot be weaned off intravenous therapy. Twelve consecutive patients who underwent pancreatectomy for control of hypoglycemia between 1979 and 1984 were recalled and evaluated for growth delay, neurologic dysfunction, and psychomotor retardation using the Revised Yale Developmental Schedules, the Peabody Picture Vocabulary, and the Draw a Man Test. Follow-up ages ranged from 1.2 to 6.0 years with a median of 3.6 years. No significant growth abnormalities were identified. No patient exhibited focal neurologic dysfunction, although some demonstrated soft neurologic signs, which did not appear to be related to their earlier hypoglycemia. Psychomotor function for the group as a whole was normal, with a mean developmental quotient (DQ) of 99.2. The DQ was average for five patients and above average for four; no patient had a DQ in the frankly subnormal range. Psychomotor development correlated better with the family's socioeconomic and educational status than with the neonatal hypoglycemia. These children are developmentally and neurologically normal despite severe neonatal hypoglycemia. Continued follow-up will be necessary to detect any late sequelae.(ABSTRACT TRUNCATED AT 250 WORDS)

Body Height↗