PubMed Health⌕ Search

Biomedical subjects

K S Lewis

Publications and source records attributed to K S Lewis.

26 records · Page 2Linked to original sources
PubMed1984

Systemic lupus erythematosus: the great masquerader.

Systemic lupus erythematosus is a chronic systemic autoimmune collagen vascular disease that can present itself in many forms throughout any system in the body. Classification, etiology, diagnosis, course of the illness with flares and remission, prognosis, treatment and emotional coping are covered. Five tables outline lab tests, classification of symptoms by tissues primarily affected, drugs used, dietary suggestions and symptoms which need the attention of a health care provider.

Adaptation, Psychological↗
PubMedDate not supplied

Pharmacokinetic evaluation of a new oral cyclosporine formulation.

STUDY OBJECTIVE: To compare the pharmacokinetics of a new oral cyclosporine preparation with those of cyclosporine solution diluted in Isocal and the intravenous formulation. DESIGN: Randomized, crossover trial. SETTING: Tertiary care referral center. PATIENTS: Seven pediatric liver transplant recipients who were receiving oral cyclosporine as part of their immunosuppressive regimen. All patients completed the study. INTERVENTIONS: Pharmacokinetic studies were performed with the intravenous and oral dosage forms. Patients received one dose of intravenous cyclosporine, and then were randomized to receive their usual oral cyclosporine dose incorporated into a chocolate wafer or mixed with Isocal. After a minimum of 3 days, the alternative preparation was administered. Serial cyclosporine blood samples were collected at predetermined intervals for 12 hours after the third dose for each regimen. Concentrations were determined by high-performance liquid chromatography. The data for the three dosage forms were fit simultaneously with a two-compartment model. MEASUREMENTS AND MAIN RESULTS: No difference was seen in F, ka, Cmax, and tmax between the two oral cyclosporine preparations (p > 0.05). No new rejection episodes occurred during the study period. CONCLUSIONS: We conclude there is no difference in the bioavailability of the oral solution and the chocolate formulation. We believe the new preparation may increase patient compliance and ensure administration of a complete dose compared with the currently marketed solution.

Administration, Oral↗
PubMedDate not supplied

Analysis of pain management in critically ill patients.

We analyzed the adequacy of pain control for 17 trauma patients during the initial part of their stay in the intensive care unit, and assessed reasons for inadequate analgesia, if it occurred. Patients, and physicians, and nurses were interviewed. A verbal pain intensity scale was used to determine whether patients received adequate analgesia. Patients were asked if the pain hindered their activities, and whether they requested pain medication from their caregivers. Caregivers were questioned whether patients received adequate analgesia. Prescribed morphine regimens and the amount of narcotic administered were analyzed. Twenty-seven percent of patients rated pain intensity as moderate and 47% as severe. Ninety-five percent of housestaff and 81% of nurses reported the patients received adequate pain control. Forty-seven percent of the patients who had moderate or severe pain asked their physician for more pain medication, and 65% asked the nurse. Thirteen residents did not order a larger dose of morphine due to concern about respiratory depression or hypotension. Morphine dosages ranged from 1-8 mg intravenously every 1-2 hours as necessary. Nurses administered less than the maximum amount ordered 58% of the time. The mean dosing interval was 2.3 hours. Barriers to adequate pain management were disparity in the perception of pain between patients and caregivers; patients not requesting more analgesia despite despite the presence of moderate to severe pain; and physician and nurse concerns about patients' adverse physiologic response to increased dosages.

Adult↗
PubMedDate not supplied

Scales to measure perceived control developed specifically for people with tablet-treated diabetes.

Scales to measure perceived control of tablet-treated diabetes were adapted from a measure designed previously for insulin users. Development of the new scale is described and the psychometric properties are examined with responses from 187 tablet-treated patients. The scales consist of seven subscales which may be combined to provide three composite scores indicating the extent to which respondents perceive Personal Control, Medical Control, and Situational Control over their diabetes. Relationships between subscales and composite scores were similar to those found previously for insulin users. Patients were significantly more likely (p less than 0.001) to make attributions to Personal Control for their diabetes management rather than to Medical or Situational Control. As before, predictable biases were found in attributions to positive and negative outcomes. Correlations with medical and other psychological variables indicated that, as expected, stronger perceptions of Personal Control were associated with lower HbA1 levels (r = -0.14; p less than 0.05), lower percent ideal body weight (r = -0.24; p less than 0.01), less Anxiety (r = -0.15; p less than 0.05), greater Positive Well-being (r = 0.21; p less than 0.01) and greater Satisfaction with treatment (r = 0.34; p less than 0.001). Complementary relationships were found with the measure of Situational Control. Wallston and Wallston's speculative Locus of Control typology was investigated using the new measures, and the findings provided support for the value of this approach.

Adult↗
PubMedDate not supplied

Current patterns of prescribing and administering morphine in trauma patients.

We attempted to characterize the current prescribing practices and administration patterns for intravenous intermittent morphine in trauma patients in a multicenter, open prospective, observational study. The subjects were 141 patients admitted to the surgical intensive care units (ICU) of five United States trauma centers within 12 hours of injury who received intermittent intravenous morphine for pain relief. The study was conducted from April 15, 1992, to February 15, 1993. Data obtained during the first 32 hours of the ICU stay included morphine regimen, doses administered, and time between doses. One hundred sixty-one orders were prescribed by surgeons. The most frequently ordered dose was 2-4 mg and the most frequently ordered interval was every hour as necessary. There was no relationship between the severity of injury and the minimum dose ordered. During the 492 nursing shifts studied, 1257 doses were administered. Of these, 44% were at or below the minimum amount prescribed by the surgeons. Thirty-three percent of the patients received a dose at an interval of more than 3 hours. We concluded that small amounts of narcotic analgesics are given to severely injured patients, and amount ordered is not affected by the severity of injury.

Adolescent↗
PubMedDate not supplied

Emotional adjustment to a chronic illness.

The emotional reaction to the diagnosis of a chronic illness can be a greater challenge than coping with the physical manifestations of the illness. This article describes and explains the determinants of the emotional reaction to the diagnosis of a chronic illness: (1) personality before the illness; (2) unresolved anger or grief from the past; (3) the suddenness, extent, and duration of life-style changes mandated by the illness; (4) familial and individual resources for dealing with stress; (5) stages of individual and family life cycle; (6) previous experience with illness or crisis; and (7) codependency in the family system. Also discussed are the stages of integrating grief process with the benefits and pitfalls of each stage and signs of acceptance. The benefits and necessity of going through the grief process are explored. People who receive diagnoses of chronic illness may find their emotional reaction more disabling than the illness itself until they go through the adjustment process to embrace the new person they have become through the illness.

Adaptation, Psychological↗