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Biomedical subjects

J S Carroll

Publications and source records attributed to J S Carroll.

7 recordsLinked to original sources

Sleep and "sundowning" in nursing home patients with dementia.

"Sundowning," a term that is sometimes equated with sleep disturbance or nocturnal delirium in dementia, is a poorly understood psychiatric phenomenon. In this study, we performed systematic, temporally specific, behavioral observations of nine profoundly demented nursing home patients 4 times an hour over a 12-hour period (1300 to 0100h) to determine whether their agitation was more likely to occur at a particular time of day. Results indicated only equivocal evidence that agitation was any worse nocturnally or during the time near sunset, thus raising the possibility that at least some components of sundowning may reflect disruptive behaviors occurring with identical frequency throughout the day but with differential impact upon nursing staff. Additional data indicated that awakening from sleep during darkness was also associated with agitation. A final result was a trend indicating the apparent worsening of agitation seasonally (greater agitation during winter), which may suggest involvement of the circadian timing system.

Activities of Daily Living

Predictors of observed sleep/wakefulness in residents in long-term care.

This cross-sectional study investigated predictors of sleep/wakefulness in residents in a skilled care nursing facility. Sleep/wakefulness was defined behaviorally by observations made four times an hour over four 12-hour observation periods. Predictors studied were mental status, functional capacity, relative likelihood of cardiovascular/respiratory, musculoskeletal, and endocrine disease, psychotropic medication intake, and presence of sleep apnea. Results based on 39 residents indicated that sleep apnea was a positive consistent predictor of observed sleep in the nursing home. Apnea generally was unrelated to other predictors. We discuss these findings in terms of the viability of this technique to study sleep as well as other potential predictors of sleep/wakefulness in elderly institutionalized patients.

Aged

A method for checking interobserver reliability in observational sleep studies.

Disturbances of the sleep/wake cycle occur frequently in nursing home residents. Because of the many technical difficulties in studying sleep and rhythms in such patients, systematic behavioral observations offer an alternative approach. In this study we describe a method for determining interrater reliability of such observations. Two individuals observed 39 nursing home residents four times per hour during daytime and nighttime hours. Results indicated high interrater reliability for both sleep/wake and the presence of apnea during sleep. Both day and night observations were made reliably. We found only 101 discrepancies of 1.160 tandem observations. These results suggests that behavioral observations are a viable approach in the study of the sleep/wake cycle in nursing home settings.

Aged

Sentencing goals, causal attributions, ideology, and personality.

Disparity in sentencing of criminals has been related to a variety of individual difference variables. We propose a framework establishing resonances or coherent patterns among sentencing goals, causal attributions, ideology, and personality. Two studies are described, one with law and criminology students, the other with probation officers. Relations among the different types of variables reveal two resonances among both students and officers. One comprises various conservative and moralistic elements: a tough, punitive stance toward crime; belief in individual causality for crime; high scores on authoritarianism, dogmatism, and internal locus of control; lower moral stage; and political conservatism. The second comprises various liberal elements: rehabilitation, belief in economic and other external determinants of crime, higher moral stage, and belief in the powers and responsibilities of government to correct social problems. Implications of these results are discussed for individual differences in sentencing, attribution theory, and attempts to reduce disparity.

Authoritarianism

Anaesthesia equipment malfunction.

Anaesthetic equipment was studied to determine whether the accuracy was improved and failure rate decreased by routine maintenance and calibration by a biomedical technician. Each piece was evaluated, and then repaired and rechecked at intervals by the same technician. Equipment failures were divided into three types: first, equipment that was completely nonfunctional; second, equipment that was functional but inaccurate; and third, equipment that was functional and accurate but needed minor repairs. The percentage of equipment failures in each group was compared on initial evaluation and after 6 months. Of the 311 pieces of equipment, 40% needed repair at the time of the initial survey; 80% was nonfunctional, and 18% was functional but inaccurate. After six months on a maintenance schedule, only 15% of the equipment needed repair, 3% was nonfunctional, and 6% was functional but inaccurate. The difference between the total percentage of equipment failure initially and after six months was statistically significant. After a regular maintenance, calibration, and checkout schedule by a biomedical technician was instituted, there was a significant improvement in the accuracy of the equipment and a reduction in the percentage of equipment needing repair.

Anesthesiology