Shortage of psychiatrists plaguing northern Ontario.
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Adolescent↗
Biomedical subjects
K Nugent
Publications and source records attributed to K Nugent.
Spectrum of invasive pulmonary aspergillosis in immunocompetent patients with chronic obstructive pulmonary disease.
Invasive pulmonary aspergillosis is a well-recognized complication in immunocompromised patients, especially those with neutropenia. We report four cases of invasive pulmonary aspergillosis in patients whose main underlying disease was chronic obstructive pulmonary disease (COPD). Two patients had an acute fatal course, one had chronic necrotizing pulmonary aspergillosis ending in an acute fatal course, and the other had a semiacute disease that responded to amphotericin B. Autopsy on three patients showed invasive pulmonary aspergillosis in both lungs, and tissue invasion was documented by transbronchial biopsy in the patient who survived. Retrospective review of all cultures that grew Aspergillus species from bronchoscopic specimens showed no false-positive results, and this procedure proved to be the most useful maneuver in making the diagnosis. Invasive pulmonary aspergillosis should be in the differential diagnosis in patients with COPD and unexplained pulmonary infiltrates.
Acute Disease↗
Psychiatric consultation with children in underserviced areas: lessons from experiences in northern Ontario.
There are only 350 child psychiatrists in Canada. It is therefore unrealistic to expect them to be able to provide sufficient direct treatment, even in small densely populated communities with abundant resources. Such expectations are even more unrealistic in underserviced, sparsely populated areas. A review of the literature on psychiatric consultation in underserviced areas is presented along with a description of the consultation process, taking advantage of the "multiplier effect." Some of the realities of mental health consultation in underserviced areas are discussed, stressing the importance of consultation as a way of professional life. Some guidelines for the psychiatric consultant are outlined which would enhance the "multiplier effect". It is maintained that the training of psychiatric residents should include a supervised experience consulting in underserviced areas. Finally, it is hoped that psychiatric training programs, funding bodies, hospitals, and agencies, will recognize the value of this use of psychiatric expertise.
Child↗
Termination of central sleep apnea episodes by upper airway stimulation using intermittent positive pressure ventilation.
A 52-year-old man presented with pure central sleep apnea syndrome that failed to respond to nasal continuous positive airway pressure (NCPAP) therapy. Intermittent positive pressure stimulation via a nasal mask was instituted using a portable positive pressure ventilator. We found marked reduction in the respiratory disturbance index, number of desaturations, and the number of arousals with this mode of therapy.
Electrocardiography↗
Clinical results of bony fixation methods in digital replantation.
Clinical results comparing different techniques of fixation in replanted digits have not been described in detail, and bony deformities after replantation have been documented only in limited series. We retrospectively analyzed our population of phalangeal replants over a 5-year period to assess the outcome of different fixation methods with regard to frequency of angulation, fracture instability, nonunion, and need for corrective osteotomy. Techniques evaluated included: single and crossed Kirschner wires, intraosseous wires with and without Kirschner wire support, and the tetrahedral (Cassel) wire. Initial results show similar early angulation deformities in all groups. Intraosseous wires alone were found to have the lowest nonunion and complication rate. The Cassel wire was found to have the highest number of digits with fixation problems. Overall, bony problems were seen in nearly 50% of replants in our series.
Bone Wires↗
A cluster of silicosis in sandblasters.
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Cluster Analysis↗
A practice model for a parent support group.
Parent support groups in acute care settings can provide families of hospitalized children with opportunity to share emotions and concerns related to the crisis experience of hospitalization with others who are experiencing similar situations. The Nugent Model of Family Support combines several concepts of caring, empowerment and family efficacy into a practical framework that clinicians can use in providing and evaluating outcomes of an acute care based parent support program.
Adaptation, Psychological↗