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Biomedical subjects

J Flannery

Publications and source records attributed to J Flannery.

At least 19 recordsLinked to original sources
PubMed2001

Teaching acute care nurses cognitive assessment using LOCFAS: what's the best method?

The Levels of Cognitive Functioning Assessment Scale (LOCFAS) is a behavioral checklist used by nurses in the acute care setting to assess the level of cognitive functioning in severely brain-injured patients in the early post-trauma period. Previous research studies have supported the reliability and validity of LOCFAS. For LOCFAS to become a more firmly established method of cognitive assessment, nurses must become familiar with and proficient in the use of this instrument. The purpose of this study was to find the most effective method of instruction by comparing three methods: a self-directed manual, a teaching video, and a classroom presentation. Videotaped vignettes of actual brain-injured patients were presented at the end of each training session, and participants were required to categorize these videotaped patients by using LOCFAS. High levels of reliability were observed for both the self-directed manual group and the teaching video group, but an overall lower level of reliability was observed for the classroom presentation group. Examination of the accuracy of overall LOCFAS ratings revealed a significant difference for instructional groups; the accuracy of the classroom presentation group was significantly lower than that of either the self-directed manual group or the teaching video group. The three instructional groups also differed on the average accuracy of ratings of the individual behaviors; the accuracy of the classroom presentation group was significantly lower than that of the teaching video group, whereas the self-directed manual group fell in between. Nurses also rated the instructional methods across a number of evaluative dimensions on a 5-point Likert-type scale. Evaluative statements ranged from average to good, with no significant differences among instructional methods.

Acute Disease↗
PubMed2001

North Carolina macular dystrophy: clinicopathologic correlation.

PURPOSE: To describe the clinical and histopathologic findings of a 72-year-old female with North Carolina macular dystrophy. METHODS: Observational case report with histopathologic correlation. Clinical examination includes slit-lamp biomicroscopy, indirect ophthalmoscopy, color fundus photography, and focal electroretinography. Histopathologic examination of the enucleated left eye performed with light microscopy. RESULTS: Light microscopy demonstrated a discrete macular lesion characterized by focal absence of photoreceptor cells and retinal pigment epithelium with attenuation of the Bruch membrane and focal atrophy of the choriocapillaris. Adjacent to the macular lesion, some lipofuscin was identified in the retinal pigment epithelium. CONCLUSION: North Carolina macular dystrophy has both clinical and microscopic appearances of a well-demarcated lesion confined to the macula, which involves the retina, pigment epithelium, and choriocapillaris.

Aged↗
PubMed2001

North Carolina macular dystrophy: clinicopathologic correlation.

PURPOSE: To describe the clinical and histopathologic findings in a 72-year-old woman with North Carolina macular dystrophy. METHODS: Clinical examination was performed by slit-lamp biomicroscopy, indirect ophthalmoscopy, color fundus photography, and focal electroretinography. Histopathologic examination of the enucleated left eye consisted of light microscopy. RESULTS: Light microscopy demonstrated a discrete macular lesion characterized by focal absence of photoreceptor cells and retinal pigment epithelium. Bruch's membrane was attenuated in the center of the lesion and associated with marked atrophy of the choriocapillaris. Adjacent to the central lesion, some lipofuscin was identified in the retinal pigment epithelium. CONCLUSIONS: North Carolina macular dystrophy has both clinical and microscopic appearances of a well-demarcated retinal and pigment epithelial lesion confined to the macula. This is consistent with the clinical impression that it is a focal macular dystrophy.

Aged↗
PubMed2000

Hypercholesterolemia: a look at low-cost treatment and treatment adherence.

PURPOSE: To determine whether a positive cholesterol-lowering effect could be achieved with a psyllium dose of 6 grams per day instead of the usual 10 grams per day as advocated by other researchers. DATA SOURCES: Randomized trial of 46 males and females with hypercholesterolemia; multivariate analysis of variance with repeated measures on 1 factor done on 28 subjects (18 in treatment group, 10 in control group) remaining after 16 weeks of treatment. CONCLUSIONS: Lipoprotein analysis at 2, 8, and 16 weeks indicated that a daily dose of 6 grams of psyllium hydrophilic mucilloid did not significantly affect serum total cholesterol nor low-density lipoproteins in either men or women with hypercholesterolemia. The effects of psyllium on hypercholesterolemia appear to be dose dependent. PRACTICE IMPLICATIONS: Although it is a low cost option, the addition of psyllium to the diet has unpleasant side-effects, including abdominal distention, flatulence, and discomfort. Because these side effects are troublesome, the lowest effective dose of psyllium may be an important factor in improving treatment adherence.

Abdominal Pain↗
PubMed2000

Coping strategies of rural families of critically ill patients.

This study explored the coping strategies of families of critically ill patients in a rural Southern Appalachian setting. A convenience sample of 30 family members of 22 critically ill patients in two rural hospitals completed the Jaloweic Coping Scale. The five most frequently used coping methods were helping, thinking positively, worrying about the problem, trying to find out more about the problem and trying to handle things one step at a time. The five most effective coping strategies were talking the problem over with friends, praying, thinking about the good things in life, trying to handle things one step at a time and trying to see the good side of the situation. Findings contradicted many of the more "negative" descriptions of Appalachian people in the literature. Similarities outweighed differences when comparing the coping styles of rural and urban populations. Findings suggest that coping strategies must be considered for positive outcomes in the delivery of care to such a rural population.

Adaptation, Psychological↗
PubMed1998

Genetic disease in offspring of long-term survivors of childhood and adolescent cancer.

Numerous case series have addressed the concern that cancer therapy may damage germ cells, leading to clinical disease in offspring of survivors. None has documented an increased risk. However, the methodological problems of small series make it difficult to draw firm conclusions regarding the potential of cancer treatments to damage the health of future offspring. We conducted a large interview study of adult survivors of childhood cancer treated before 1976. Genetic disease occurred in 3.4% of 2,198 offspring of survivors, compared with 3.1% of 4,544 offspring of controls (P=.33; not significant); there were no statistically significant differences in the proportion of offspring with cytogenetic syndromes, single-gene defects, or simple malformations. A comparison of survivors treated with potentially mutagenic therapy with survivors not so treated showed no association with sporadic genetic disease (P=.49). The present study provides reassurance that cancer treatment using older protocols does not carry a large risk for genetic disease in offspring conceived many years after treatment. With 80% power to detect an increase as small as 40% in the rate of genetic disease in offspring, this study did not do so. However, we cannot rule out the possibility that new therapeutic agents or specific combinations of agents at high doses may damage germ cells.

Adolescent↗
PubMed1998

Factors in job satisfaction of the psychiatric clinical nurse specialist.

This exploratory descriptive study examines variables that affect the job satisfaction of psychiatric clinical nurse specialists (CNSs). A convenience sample of 52 psychiatric CNSs revealed a moderate amount of job satisfaction as indicated on the Mueller/McCloskey Satisfaction Scale. CNSs employed outside hospitals and those who had a private practice component to their jobs had greater mean job satisfaction than those who were employed in the hospital setting and did not have a private practice besides this work (p = 0.0188). Hospital executives are urged to look at the structures of their organizations to enhance the job satisfaction of these advanced nurses who work in a hospital.

Adult↗
PubMed1997

Time trend of female breast carcinoma in situ by race and histology in Connecticut, USA.

A rapid increase of female breast cancer has been reported in many areas of the world and the reasons are not fully understood. While some have attributed the increase to the increasing detection of early stage breast cancer through mammography screening, few studies have directly examined the time trend of in situ breast cancer specifically. This study included all incident cases of female breast carcinoma in situ reported to the Connecticut Tumor Registry between 1973 and 1992. The age-adjusted incidence rates and age-specific incidence rates were calculated by histology and by race. The age-adjusted incidence rates were standardised to the 1970 United States standard million population. The study found that the overall age-adjusted incidence rate of in situ breast cancer has increased dramatically, from 3.53/100000 in 1973-1975 to 17.51/100000 in 1991-1992. The increase was not uniform during the past two decades of cancer registration. In fact, most of the observed rise has occurred since the early 1980s. This increase was found in both Caucasians and Blacks. The results by histology indicate that the dramatic increase in carcinoma in situ is mostly attributable to an increase in ductal carcinoma in situ. The increase was also observed in all age groups 40 years and over. These results are consistent with the use pattern and the reported effect of mammography screening. Therefore, these results are qualitatively consistent with the idea that mammography screening is largely responsible for the recent upsurge in female breast cancer incidence in this population. The study also found that the age group 40-49 years in whites experienced a rapid increase in incidence that began in the same time period as the older age groups, but it has since levelled off. The potential impact of the highly publicized debate regarding the efficacy of mammography in this age group in recent years is discussed.

Adult↗
PubMed1997

Are cancers of the salivary gland increasing? Experience from Connecticut, USA.

BACKGROUND: Recent studies indicate that cancers of the salivary gland are increasing, and the factors responsible for the increase are unknown. Artefactual changes, such as shift in classifying cancers of the floor of the mouth to cancers of the salivary gland, could affect the time trend for salivary gland cancer. METHODS: The current study examined the time trends for cancers of the salivary gland and for cancers of the floor of the mouth and lower gum by using Connecticut Tumor Registry data for the time period 1935-1992. A regression model was used to identify the components of birth cohort, period and age as determinants of the observed time trend. RESULTS: Cancers of the salivary gland have recently increased in Connecticut, with a relative risk of 1.48 (95% CI: 1.06-2.08) for females in 1990-1992 compared to 1980-1984, and a comparable relative risk of 1.60 (95% CI: 1.16-2.22) for males. The increase was found in all age groups 40 and over, particularly among those aged 70 and over. The results from age-period-cohort modelling show a recent upturn in the trend for period slopes, with no clear increase from recent birth cohorts, which is consistent with the results from univariate analyses suggesting no clear increase among those under 40 years of age. CONCLUSION: Our results suggest that artifactual changes, such as a shift in designation of cancer sites, increasing use of the needle aspirate biopsies, and greater access to medical care for the elderly, may have largely contributed to the rising trend. The known risk factors, radiation exposure and a history of a prior cancer, can hardly explain the observed increase. The Epstein-Barr virus infection has only been associated with certain types of rare squamous cell carcinomas of the salivary gland in the Eskimo population. The AIDS epidemic also cannot explain why older age groups have accounted for most of the increase in incidence of the disease. An examination of the incidence rates for cancers of the salivary gland from other populations may help to clarify the issue.

Adult↗
PubMed1997

A thirty-eight year comparison of cancer incidence and mortality among employees at a Connecticut chemical plant.

An important aspect of occupational mortality is the fact that death registration is complete and has good specificity and sensitivity for those cancers with poor survival. However, if available and complete, cancer incidence data are preferable. A unique opportunity presented itself at The Dow Chemical Company's Allyn's Point plant (Gales Ferry, Connecticut) to conduct a cancer incidence and mortality study since the plant began operation in 1951, several years after the establishment of the Connecticut Tumor Registry. All male employees (N = 666) with one or more years of service from 1951-1989 were eligible for the study. Altogether there were 47 primary incident cancers which represented 40 individuals. The Standardized Incidence Ratio (SIR) for all cancer was 124 (95% confidence interval [CI] 91-165). There were 23 deaths reported for all cancers (Standardized Mortality Ratio [SMR] 87, 95% CI 55-131). Only laryngeal cancer incidence was statistically significant (Standardized Incidence Ratio [SIR] 417, 95% CI 135-972). After review of the work history records, this association was found to be inconsistent with a common exposure hazard at the plant.

Adult↗
PubMed1996

Time trend and age-period-cohort effect on incidence of bladder cancer in Connecticut, 1935-1992.

Earlier studies indicated that the incidence rates for bladder cancers rose rapidly in both the United States and Europe. Tobacco smoking is considered to be the major risk factor for urinary bladder cancer, and recent studies from Connecticut show that several smoking-related cancers have started leveling off or decreasing. The time trend for bladder cancer, however, is not clear in Connecticut. The current study examined the long-term trend of bladder cancer in Connecticut. Our results show that urinary bladder cancer has been increasing, with a marked increase among males. The rate of increase, however, has slowed since the early 1980s. Birth-cohort examination shows that the rates have leveled off for those born after about 1935 in both males and females. Age-period-cohort modeling results also show that the birth-cohort patterns of bladder cancer are somewhat similar to those observed for lung cancer in Connecticut, thus supporting the findings from analytical epidemiologic studies which indicate that cigarette smoking is one of the major risk factors for urinary bladder cancer. Our results also suggest that the difference in environmental and occupational exposures between males and females may be responsible for the large difference in the incidence rate of bladder cancer seen between the sexes.

Adult↗
PubMed1996

Time trend and age-period-cohort effect on incidence of thyroid cancer in Connecticut, 1935-1992.

Recent studies from Europe suggest a continuing increase in thyroid cancer, but it is unclear whether this trend also applies to the United States. The current study examined the long-term trend of thyroid cancer in Connecticut. Our results show that the overall age-adjusted incidence rate of thyroid cancer has been increasing in Connecticut, from 1.30/100,000 in 1935-1939 to 5.78/100,000 in 1990-1992 in females, and from 0.30/100,000 in 1935-1939 to 2.77/100,000 in 1990-1992 in males. The increase mainly comes from papillary carcinoma of the thyroid. The birth cohort analyses indicate that the increase in thyroid cancer occurred among cohorts born between 1915 and 1945, which experienced an increase of 31.4% every 5 years in males and 17.3% in females over the period 1960-1979. For those born since the 1945 cohort, the incidence has been decreasing, at rates of 9.3% and 8.3% every 5 years over the period 1975-1992 in males and females, respectively. Age-period-cohort modeling results also suggest a strong birth cohort effect on the observed time trend in both sexes, which closely follows the introduction of radiation treatment of benign childhood conditions in the head and neck between 1920 and the 1950s in the United States. Our results are consistent with the suggested radiation hypothesis, indicating that radiation treatment of benign childhood conditions in the head and neck is largely responsible for the observed increase of thyroid cancer in Connecticut.

Adenocarcinoma, Follicular↗
PubMed1996

Continuing increase in incidence of germ-cell testis cancer in young adults: experience from Connecticut, USA, 1935-1992.

The current study is designed to examine long-term trends by histologic types of testis cancer in Connecticut. A regression model was used to identify age, period, or cohort as determinants of the time-trend on histologic types of testis cancer. The results from this descriptive epidemiologic study show that the overall age-adjusted incidence rate of testis cancer has increased 3.5-fold in Connecticut during the past nearly 60 years of cancer registration. The rates for seminoma and non-seminoma have been increasing since the mid-1950s and increase in a similar manner for those aged 15 to 49. The largest increase was observed in the age groups 20 to 44 for seminoma and 15 to 34 for non-seminoma. The observed increase was limited to whites. The results from age-period-cohort modeling suggest that the observed increase in seminoma before 1950s could be largely attributable to a period effect, while the increase for cohorts born after about 1910 both for seminoma and for non-seminoma are mainly explained by a strong birth-cohort effect. Therefore, the observed increase in germ-cell testis cancer in this population is likely to continue in the coming years. Thus far, the proposed hypotheses, such as exposure to DES in utero, earlier lifetime exposure to viruses, trauma or unusual amounts of heat to the testis, cannot adequately explain the observed incidence patterns of testis cancer. Analytical epidemiologic studies with large sample size are urgently needed to examine the risk factors responsible for the increase.

Adolescent↗
PubMed1996

The occurrence of serum autoantibodies against enolase in cancer-associated retinopathy.

Cancer-associated retinopathy (CAR) is an uncommon paraneoplastic disease in which degeneration of the retina occurs as a remote effect of cancer in a distant part of the body. Immunoreactivity of sera from CAR patients and controls have been analyzed. Immunostaining of human retinal proteins showed that a soluble protein of Mr approximately 46 kDa (p46) is labeled by antibodies from several CAR patients with various types of cancer (lung, breast, bladder, prostate, salivary gland, and gastrointestinal tract cancer and chronic lymphocytic leukemia). These sera did not show reactivity with the 23-kDa protein previously associated with CAR. To identify and further characterize p46, the retinal protein was purified to homogeneity by anion-exchange chromatography and preparative gel electrophoresis. Protein sequence analysis of the peptides from p46 revealed a high homology with human enolase, an important glycolytic enzyme. Although enolase has been previously identified as a product of several types of tumors, and enolase activity has been detected in the sera of some cancer patients, the existence of autoantibodies directed to enolase has not been described. This is the first report of the presence of serum antibodies to retinal enolase in the patients with cancer and the CAR syndrome. When antibodies of specific isotypes (IgG, IgM, and IgA) were measured, IgG1 isotype was dominant. The significance of these antibodies for the disease process is under investigation.

Aged↗
PubMed1996

Primary brain tumor incidence rates in four United States regions, 1985-1989: a pilot study.

There has been controversy in the last decade over whether the reported increase in brain tumors reflects a real increase in incidence rates. Incidence data on the full spectrum of brain tumors is lacking in the discussion since current cancer reports in the United States are restricted to malignant tumors. Data on tumors from four population-based cancer registries in the United States were compiled to provide incidence rates of benign and malignant brain tumors and to assess the feasibility of providing these data on a larger scale. A total of 8,070 primary tumors diagnosed from 1985 to 1989 in Connecticut, Massachusetts, Missouri and Utah were obtained. Brain tumors were defined using the International Classification of Diseases for Oncology codes 191.0-191.9, 192.0-192.3, 192.8-192.9 and 194.3-194.4. Stratum-specific incidence rates by location and histology were estimated by sex, age and region. Age-adjusted rates were standardized to the 1970 United States population. An age-adjusted incidence rate of 9.4/10(5) was observed, which reflects a 36% increase in males and a 68% increase in females over the rate based on malignant tumors alone from the Surveillance, Epidemiology and End Results cancer reporting system. Incorporating benign tumors into cancer registry data would increase the reported incidence rates primarily in females and for meningiomas and nerve sheath tumors. This expanded incidence rate represents a substantial improvement in the ability to describe the occurrence of these complex tumors by subtype with a modest increase in overall case registrations for cancer registries. Centralization of data on all brain tumors appears feasible. Variations in histology-specific rates across regions raises questions that need to be addressed about the ascertainment and accuracy of tumor classification. Use of the cancer registration system to improve the reporting of brain tumors in the United States is important to our understanding of the occurrence of these complex tumors and to our ability to conduct large-scale epidemiologic investigations.

Adolescent↗
PubMed1995

Time trend in pancreatic cancer incidence in Connecticut, 1935-1990.

A total of 13,246 incident pancreatic cancer cases, reported to the Connecticut Tumor Registry between 1935 and 1990, were included in our study. Results indicate that the overall age-adjusted incidence rate of pancreatic cancer increased between 1935 and 1964 in males, and leveled off thereafter. Since 1975, the incidence rate has in fact been decreasing, from 12.04/100,000 in 1975-79 to 10.44/100,000 in 1985-90. In females, the overall age-adjusted incidence rate also increased between 1935 and 1974. Since then, however, it has remained relatively stable. Age-specific incidence rates also show no signs of an increase in rate from any age group, or from either sex for recent birth cohorts. There is also no clear increase in the incidence of pancreatic cancer in any of the ethnic/gender categories since the early 1970s. Age-period-cohort modeling shows that the increasing birth cohort trend peaked among those born around 1920-1925 and, for recent birth cohort, a slightly decreasing trend was observed in both males and females. Our study reveals no signs of an increase in the immediate future in pancreatic cancer incidence rate in any of the sex, ethnic and age groups in Connecticut.

Adult↗
PubMed1995

Cognitive assessment in the acute care setting: reliability and validity of the Levels of Cognitive Functioning Assessment Scale (LOCFAS).

Nurses have responsibility for accurate assessment of cognitive functioning for traumatic brain injured (TBI) patients early in the posttrauma period to enhance rehabilitation with appropriate care planning. To meet this need the Levels of Cognitive Functioning Assessment Scale (LOCFAS) was adapted from the Rancho Los Amigo Levels of Cognitive Functioning instrument. One validity and three reliability studies were conducted using videotapes of five TBI patients at different levels of cognitive functioning. Interrater and intrarater reliability was assessed using coefficient kappa. With raters experienced in assessing cognitive functioning, agreement among cognitive levels was 1.00 with a mean agreement of .997 (SD = .006) for individual items. With inexperienced raters in cognitive assessment, mean agreement for levels was .839 (SD = .120) and for individual items, .830 (SD = .052) Intrarater reliability, after a two-week interval, yielded a mean agreement of .860 (SD = .088) for levels. Criterion-related validity of the LOCFAS was demonstrated by correlating it with the Rancho Los Amigos Levels of Cognitive Functioning scale. The resultant Pearson r correlation was .929. Implications for nursing practice and nursing education are discussed.

Acute Disease↗