PubMed Health⌕ Search

Biomedical subjects

L Walker

Publications and source records attributed to L Walker.

At least 73 records · Page 4Linked to original sources
PubMed1999

Developing individualized care in nursing homes: integrating the views of nurses and certified nurse aides.

Despite recent attention devoted to the development of individualized care in nursing homes, empirical research assessing changes in practice is quite limited, and very few studies have explored specifically the experiences and perceptions of certified nurse aides (CNAs). This study reports findings from a comparative analysis conducted on a data set including quantitative and qualitative data from CNAs (N = 289) and nurses in Connecticut (N = 245). Measures of obstacles to individualized care and needs for future supports were explored. A number of significant differences in perceptions of obstacles to providing individualized care were found. The nurses were significantly more likely to identify the following impediments to change: cost (p < .0001), concepts not integrated into work (p < .0001), lack of administrative support (p < .10), and staff attitudes (p < .10). The CNAs were significantly more likely to report inadequate staffing (p < .001), lack of interdisciplinary teams (p < .001), and resident and family attitudes (p < .01) as problematic. These findings suggest substantial discordance among nurses and CNAs on a number of important issues surrounding individualized care. Such disparate perceptions pose challenges to nursing homes committed to the implementation of individualized care alternatives. Successful approaches must consider the various vantage points of caregivers and administrators.

Aged↗
PubMed1998

Real-time quantitative measurement of autocrine ligand binding indicates that autocrine loops are spatially localized.

Autocrine ligands are important regulators of many normal tissues and have been implicated in a number of disease states, including cancer. However, because by definition autocrine ligands are synthesized, secreted, and bound to cell receptors within an intrinsically self-contained "loop," standard pharmacological approaches cannot be used to investigate relationships between ligand/receptor binding and consequent cellular responses. We demonstrate here a new approach for measurement of autocrine ligand binding to cells, using a microphysiometer assay originally developed for investigating cell responses to exogenous ligands. This technique permits quantitative measurements of autocrine responses on the time scale of receptor binding and internalization, thus allowing investigation of the role of receptor trafficking and dynamics in cellular responses. We used this technique to investigate autocrine signaling through the epidermal growth factor receptor by transforming growth factor alpha (TGFalpha) and found that anti-receptor antibodies are far more effective than anti-ligand antibodies in inhibiting autocrine signaling. This result indicates that autocrine-based signals can operate in a spatially restricted, local manner and thus provide cells with information on their local microenvironment.

Animals↗
PubMed1998

Molecular mechanisms of auxin action.

The plant growth hormone auxin has an important role in a variety of plant growth and developmental processes. Identification of transcription factors, some with defined genetic function, has shed new light on the mechanisms of auxin regulated gene expression. In addition, the molecular characterization of genes required for auxin response indicates that regulated protein degradation by the ubiquitin-proteosome pathway has an important function in auxin action.

Arabidopsis↗
PubMed1998

Medicaid estate planning: practices and perceptions of Medicaid workers, elder law attorneys, and certified financial planners.

This study examined Medicaid estate planning (MEP) through the experiences and perceptions of three groups in Connecticut: Medicaid eligibility workers (n = 128), elder law attorneys (n = 41), and certified financial planners (n = 29). Respondent groups varied significantly with regard to their perceptions of prevalence and magnitude of MEP, the nature of transferred assets, mechanisms for transfers, and characteristics of the "typical" client participating in asset divestiture for the purpose of qualifying for Medicaid. This substantial lack of concordance among those professionals most closely involved with MEP poses challenges for policy and research in this area.

Aged↗
PubMed1998

A randomised controlled trial of postal versus interviewer administration of a questionnaire measuring satisfaction with, and use of, services received in the year before death.

STUDY OBJECTIVES: To develop a short form of an interview schedule used successfully in previous national surveys of care for the dying, and to investigate the effect of administering it by post on response rate, response bias and on the nature of responses to questions. DESIGN: Randomised controlled trial. SETTING: An inner London health authority. PARTICIPANTS: Informants (person registering death) of random sample of cancer deaths between June 1995 and July 1996. MAIN RESULTS: The shortened questionnaire (VOICES) has 158 questions. Response rate did not differ significantly between postal and interview groups (interview; 56% (69 of 123), postal: 52% (161 of 308). Responders in the two groups did not differ in terms of their sociodemographic characteristics. Postal questionnaires had significantly more missing data, particularly on questions about service provision and satisfaction with services. Responses to questions differed between the groups on 11 of 158 questions. Interview group respondents were more likely to give top ranking responses to questions on service satisfaction and symptom control. CONCLUSIONS: Postal questionnaires are an acceptable alternative to interviews in retrospective post-bereavement surveys of care for the dying, at least in terms of response rate and response bias. However, the increased costs of interview surveys need to be balanced against the fact that postal questionnaires result in more missing data, and possibly less reliable answers to some questions. Caution is needed in combining results from the two data collection methods as interview respondents gave more positive answers to some questions.

Adult↗
PubMed1998

Microbial contamination of three-way taps on arterial lines.

Arterial lines with three-way taps are used to measure blood pressure and aspirate blood, and are a potential source of catheter-related sepsis. Swabs were taken daily from 118 three-way taps on 98 arterial lines in a general intensive care unit. Infusion lines were changed weekly but arterial cannulae were not changed routinely. An overall contamination rate of 24.6% was found with the predominant organism being coagulase negative staphylococcus. The three-way taps became increasingly contaminated with time but this was shown to be unrelated to the manipulation rates. Blood culture organisms in those showing contamination of the three-way taps showed no relationship to the bacteria causing the contamination.

Arteries↗
PubMed1998

[Contribution of chromosomal abnormalities to in vitro fertilization failures].

BACKGROUND: Present knowledge of mechanisms involved in human fertilization has uncovered a new group of pathologic conditions that have been generically named fertilization abnormalities. AIM: To determine the contribution of chromosomal alterations to in vitro fertilization failures. MATERIALS AND METHODS: A cytogenetic analysis of oocytes that were not fertilized after insemination with normal spermatozoa. Oocytes were obtained from patients subjected to in vitro fertilization in a public hospital of Metropolitan Santiago. Ovulation was induced in these patients administering GnRh-a, FSH, HMG and HCG. The double fixation technique described by Wramsby was used to obtain chromosomes. RESULTS: One hundred and seven oocytes coming from 45 women aged 25 to 42 years old were studied. The frequency of aneuploidy in these oocytes was 37.3%, with a 11.8% of hypohaploidy, a 21.6% of hyperhaploidy and a 3.9% of diploid oocytes. In hyperhaploid as well as in hypohaploid oocytes, the chromosomes involved in aneuploidy pertained to groups D. and G. CONCLUSIONS: Although the total frequency of aneuploidy is within normal ranges, the frequency of hyperhaploidy is superior to previous reports. An explanation for this finding could be that the occurrence of a lack of disjunction with chromosomal retention in the parental cell occurs with a higher frequency than that in which the chromosomes are retained in the polocyte. We also suggest that oocyte chromosomal aneuploidy could contribute to the failure of in vitro fertilization procedures.

Adult↗
PubMed1997

Preadmission testing.

Explore the source record for details and available documents.

Ambulatory Surgical Procedures↗
PubMed1997

Periotest values of dental implants in the first 2 years after second-stage surgery: DICRG interim report no. 8. Dental Implant Clinical Research Group.

In 1991, the Dental Implant Clinical Research Group initiated a long-term clinical study in cooperation with the Department of Veterans Affairs to investigate the influence of implant design, application, and site of placement on clinical performance and crestal bone height. As part of this investigation, Periotest values for 2,212 root from implants were determined at second-stage surgery and during a 24-month follow-up period. Mean Periotest values decreased for implants placed in quality 1 and 2 bone, did not change for implants in quality 3 bone, and increased for implants in quality 4 bone. Implants in the posterior maxilla and single implants in the anterior maxilla had increasing mean Periotest values as compared with decreasing values for implants in other regions. Mean Periotest values for uncoated implants decreased gradually to approach those of hydroxyapatite-coated implants.

Adult↗
PubMed1997

Assessing capacity to participate in discussions of advance directives in nursing homes: findings from a study of the Patient Self Determination Act.

OBJECTIVE: To better understand the implementation of the Patient Self-Determination Act (PSDA) in long-term care, with a focus on the informing process as it affects advance directives. DESIGN: Retrospective cohort study of nursing home admissions, using medical record reviews, and a companion qualitative survey using key informant interviews. SETTING: Eleven nursing homes in Connecticut. PARTICIPANTS: A total of 600 residents randomly selected from six randomly chosen nursing homes and 19 key informants selected from five purposely sampled nursing homes in Connecticut. MEASURES: Institutional compliance with the PSDA requirement to provide written information about advance directives at admission and aspects of the informing process, including to whom the information is given. RESULTS: Compliance with the PSDA requirement to provide information at admission is high (90.7 of admissions in the post-PSDA cohort received information within 1 week of admission). However, in nearly 70% of admissions in which information was provided, someone other than the residents received the information. Staff often cited the resident's cognitive impairment as a reason for excluding residents from this informing process. However, even among those residents judged to be alert and oriented at admission, someone other than the resident received the information 47.7% of the time. CONCLUSIONS: Substantial numbers of residents may be inappropriately excluded from participating in discussions because of difficulties in determining decisional capacity to discuss future treatment wishes. The research highlights the difficulties of enhancing resident participation and autonomy in long-term care through procedural regulations such as the PSDA. More reliable methods of determining resident decisional capacity are needed to integrate the full intent of the PSDA into clinical practice in long-term care.

Advance Care Planning↗
PubMed1997

'Since male doctors were pushing us aside, we had to elbow our way through'. A history of the South African Society of Medical Women.

This paper aims to document the history of the South African Society of Medical Women (SASMW). It examines the aims and objectives of the society and the work it undertook, and briefly assesses its impact and the reasons for its decline. The material presented in this paper is based on data gathered through the use of two qualitative research methods, viz. intensive interviewing and archival/documentary analysis. This paper demonstrates that the SASMW was established in response to gender discrimination within and outside the medical profession. It argues that these women played an important role in challenging discriminatory practices and legislation, and suggests that the society's impact was most significant in the first two decades of its existence. Furthermore, it argues that it was unable to sustain its membership and activities during the late 1970s and 1980s as it did not respond adequately to the changing social and political climate and the altered racial and gender composition of the medical profession.

Female↗
PubMed1997

Resisting constraints, creating opportunities. The experiences of some early medical women.

This paper aims to document the experiences of some women doctors who graduated between 1924 and 1940. It highlights some of the difficulties they encountered in establishing themselves as respected medical practitioners and briefly describes the social context in which they worked. The data for this paper were gathered through the use of one qualitative research method, viz. intensive interviewing. This paper draws on seven in-depth interviews. It focuses on two aspects of these women's professional lives: their medical training and their career paths. It seeks to demonstrate that while some were subject to discriminatory practices by a male-dominated medical profession, they were also involved in pioneering work and made their mark as respected practitioners.

Career Choice↗
PubMed1996

Extensive areas of aneuploidy are present in the respiratory epithelium of lung cancer patients.

According to the field cancerisation theory the entire upper aerodigestive tract has been mutagenised, thereby placing the affected individual at risk for the development of one or more cancers. To investigate this concept we studied the respiratory epithelium in lungs bearing cancer, including bronchi, bronchioles and alveoli. After identifying preneoplastic and preinvasive lesions by light microscopy, we determined the DNA content of their nuclei in Feulgen-stained sections using a high-performance digitised image analyser. Archival material from 35 resected cases of non-small-cell lung cancer (NSCLC) was selected, including 16 central tumours (mainly squamous cell carcinomas) and 19 peripheral tumours (mainly adenocarcinomas) and five resected cases of metastatic tumour from extrathoracic primary sites. Of the NSCLCs, 31/35 (89%) were aneuploid, as were 60% of the metastases from extrathoracic sites. Multiple, focal areas of preneoplasia or preinvasive carcinoma were present in the selected cases. The lesions ranged in severity from hyperplasia through metaplasia and dysplasia to carcinoma in situ. Aneuploid preinvasive lesions were not noted in association with the four diploid tumours but were present only when the accompanying NSCLC was aneuploid. With both central and peripheral tumours, aneuploid preneoplastic lesions were more frequent in the peripheral parts of the lung (bronchioles or alveoli) than in the central bronchi. Both the degree and incidence of aneuploidy increased with progressive severity of morphological change. Aneuploidy was not found in preinvasive lesions accompanying the five metastatic cases. Our findings provide strong support for the concept of field cancerisation.

Adenocarcinoma↗