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Biomedical subjects

J Disch

Publications and source records attributed to J Disch.

At least 19 recordsLinked to original sources
PubMed2003

Leishmania/HIV co-infection in Brazil: an appraisal.

Given the epidemiology of human leishmaniasis and AIDS in Brazil, numerous cases of Leishmania/HIV co-infection might be expected. Relatively few Brazilian cases have been reported, however, even from regions where the overall incidences of HIV and Leishmania infection are both relatively high. Many cases of co-infection probably go undetected because of a lack of awareness among clinicians or limited access to appropriate diagnostic methods. In contrast to the situation in Europe, intravenous-drug users do not predominate among those exposed to HIV infection in Brazil. The success of the Brazilian programme for the free and universal distribution of antiretroviral drugs has decreased the prevalences of the commoner opportunistic infections among HIV-positives and increased the longevity of AIDS cases. Recent changes in the epidemiological patterns of HIV and Leishmania infections are likely to lead to a greater degree of overlap and a greater risk of co-infection and they justify increased alertness. This review of the co-infection in Brazil addresses three main topics: the current situation, in terms of the epidemiology of AIDS and Leishmania infection; the related epidemiological trends and their likely impact on the co-infection; and the co-infection cases reported in Brazil by June 2003.

AIDS-Related Opportunistic Infections↗
PubMed2001

The role of the clinical nurse specialist in creating a healthy work environment.

The clinical nurse specialist (CNS) contributes to a healthy work environment through partnerships with the nursing staff, nurse manager, physicians, and other colleagues across the health system. Examples of these partnerships are described in this article, highlighting how the work of the CNS influences the care that patients and families receive, shapes the practice environment, and fosters collegial and respectful relationships among caregivers. The CNS is a pivotal figure in creating an environment where nurses can provide the care that is needed and feel valued for their work. Partnership with a variety of clinicians enables the CNS to influence critical care nursing practice, the intensive care unit team, and the environment in which care is provided.

Education, Nursing, Graduate↗
PubMed2001

Medical directors as partners in creating healthy work environments.

Relationships between nurses and physicians in the intensive care unit can range from collegial and supportive to dysfunctional and abusive. When there is trust, open communication, respect, and a sense of camaraderie, the work is still challenging but gets done: priorities are met and people feel good about what they are doing. When these key elements are missing, satisfaction on the part of staff and patients decreases and turnover and costs increase. More importantly, research findings suggest that improving collaboration and teamwork are more than "feel-good" exercises: patient outcomes of care can be jeopardized when nurses, physicians, and other members of the critical care team are not communicating or collaborating. The nurse manager and medical director of the unit, as leaders of this team, are responsible for ensuring not only that quality care is delivered to patients, but also that the environment is supportive to caregivers. Purposefully establishing a collaborative partnership and then modeling these behaviors to the rest of the team, and holding them accountable, are key steps in creating an environment that is healing to patients, families, and caregivers.

Critical Care↗
PubMed1997

Creating a healthy work environment in the midst of organizational change and transition.

In the midst of organizational change and transition, the need for a healthy work environment is greater than ever. Leaders may be in a position of leading staff on a journey they would rather not be on. Although there may not be a choice of destination, there are many decisions to be made along the way that will impact the health and quality of the journey. Creation of a healthy work environment does not occur overnight. It requires acknowledgment of the reality of the present environment, clear behavioral expectations and standards, systems, and structures to ensure the organizational changes are enduring and a means to assess continually the health of the work environment. Leaders have an opportunity and a responsibility to structure organizations in such a way that dignity, integrity, honesty, and compassion are preserved.

Hospitals, University↗
PubMed1993

An innovative approach to telemetry monitoring.

To use staff more effectively on a medical telemetry unit, nurses collaborated with clinical engineers to incorporate a commercially available pocket pager with a dysrhythmia detection system. Nurses carry a pocket pager which beeps and displays the patient's room number when a dysrhythmia is detected. This system eliminates the need for a telemetry monitor watcher and provides nurses with ongoing information about their patients. It also created an annual savings of approximately $130,000.

Arrhythmias, Cardiac↗
PubMed1991

Competence statements for differentiated nursing practice in critical care.

The demand for high-quality patient care in the current complex health care environment and the variety of today's available nursing education programs dictate a need to differentiate nursing practice into technical and professional roles. These roles are based on competencies acquired in ADN and BSN degree programs and implemented in practice settings where the contributions of all nurses are valued. To create a preferred future, AACN has developed a model for differentiated nursing practice in critical care. The model is a guideline for those nurses and institutions who may be or will be involved in changing practice patterns. The model does not support or encourage the elimination or disenfranchisement of any individual or groups of nurses. These statements were developed to address specific behavior that reflects the valuable contributions of each category of nurses within critical care nursing. The statements provide a model for creating efficient and effective practice patterns that may contribute to high-quality outcomes for critically ill patients and their families.

Clinical Competence↗
PubMed1983

The time is now.

Explore the source record for details and available documents.

Economics, Medical↗
PubMedDate not supplied

[The working place and psychovegetative disorders].

Concept of a questionnaire for industrial workers to investigate the characteristics of their job demands, their individual claims, psychovegetativ disorders and job dissatisfaction. First results of a preliminary test on 54 selected shift workers.

Autonomic Nervous System↗
PubMedDate not supplied

Oral fluids for the immunodiagnosis of Schistosoma mansoni infection.

Saliva and oral transudate were evaluated for their potential as human specimens in the detection of IgG antibodies against soluble Schistosoma mansoni egg antigen (SEA). Preliminary laboratory testing of 49 subjects, 37 with parasitological proven infection and 12 negative controls, displayed 100% sensitivity in ELISA using serum and oral transudate and 94.6% using saliva. The specificity of the ELISA with serum was 100% versus 91.7% with both oral fluids. Significant Spearman rank correlations of anti-SEA IgG levels with egg counts were observed for serum, oral transudate and saliva (P < 0.05). The sensitivity of dot-ELISA was 100% for serum, 89% for transudate and 81% for saliva, and specificity was 100% for all 3 samples. The immunodiagnostic value of ELISA for the detection of anti-SEA IgG antibodies in oral transudate was further evaluated in 197 individuals from an endemic area of Brazil. The ELISA using serum and oral transudate showed sensitivities of 98.8% and 100% respectively and specificities of 67.8% and 64.3% respectively. Use of oral fluids for the diagnosis of S. mansoni infection was equivalent to sera with respect to test efficacy, offering an alternative to blood collection.

Adolescent↗
PubMedDate not supplied

The role of nutritional status and insulin-like growth factor in reduced physical growth in hepatosplenic Schistosoma mansoni infection.

The influence of nutritional status and hormonal growth activity on the impaired somatic development of adolescents with the hepatosplenic clinical form of Schistosoma mansoni infection (HS), the intestinal form with high (IH) or low (IL) egg output and non-infected (NI) individuals was evaluated (in Comercinho, Minas Gerais State, Brazil, in 1996-97) by measuring body mass index (BMI), insulin-like growth promoting factor (IGF-I) and its carrier protein (IGFBP-3). BMI, IGF-I and IGFBP-3 concentrations were significantly lower in the HS group compared with the IH and the NI groups, irrespective of age. BMI did not remain associated with the clinical form in the bi-variate model that included IGF-I and BMI or IGFBP-3 and BMI, suggesting that in these groups IGF-I and IGFBP-3 levels were related to the clinical form but independent of nutritional status. It is suggested that physical growth impairment in hepatosplenic S. mansoni infection results from the synergistic action of both hepatic damage and nutritional restriction.

Adolescent↗
PubMedDate not supplied

Detection of circulating Leishmania chagasi DNA for the non-invasive diagnosis of human infection.

A polymerase chain reaction (PCR) assay for the detection of Leishmania spp. DNA in peripheral blood was optimized and evaluated for the diagnosis of human visceral leishmaniasis (VL) in Brazil during May 2001 to December 2002. Optimization of the technique resulted in a detection limit of 1.65 fg of purified L. (L.) chagasi DNA, equivalent to 1.65 x 10(-2) parasites. Leishmania DNA was detected in the blood of 48 of 53 patients with parasitologically-confirmed VL, which corresponds to a sensitivity of 91%. No DNA was detected in the peripheral blood of 15 healthy, non-exposed volunteers, giving a specificity of 100%. We conclude that detection of parasite DNA in peripheral blood offers a non-invasive, sensitive and rapid method for the detection of VL caused by L. (L.) chagasi.

Animals↗
PubMedDate not supplied

Daily fluctuation of levels of circulating cathodic antigen in urine of children infected with Schistosoma mansoni in Brazil.

The fluctuation of circulating cathodic antigen (CCA) levels in urine was studied in 69 Brazilian school-children infected with Schistosoma mansoni and compared to egg counts. Faeces and urine samples were simultaneously collected at 7 times during a period of 2 weeks. CCA was determined by enzyme-linked immunosorbent assay and could be detected in 96% of the urine samples; the individual mean CCA level ranged from 609 to 350,700 pg/mL. 90% of the faecal samples contained S. mansoni eggs and the individual mean egg output ranged from 9 to 5510 eggs/g. The Spearman rank correlation coefficient between these individual means was 0.69. Kendall's coefficient of concordance (W) was 0.88 for CCA levels and 0.80 for egg counts.

Adolescent↗