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Biomedical subjects

L Ware

Publications and source records attributed to L Ware.

14 recordsLinked to original sources
PubMed2003

Plasma surfactant protein levels and clinical outcomes in patients with acute lung injury.

BACKGROUND: Because injury to the alveolar epithelial barrier is a characteristic feature of acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS), plasma surfactant protein levels may have prognostic value. To test this hypothesis plasma surfactant proteins A and D (SP-A and SP-D) levels were measured in patients with ALI or ARDS enrolled in the NHLBI sponsored multicentre ARDS Network randomised controlled trial of a 6 ml/kg v 12 ml/kg tidal volume strategy. METHODS: Data from 565 participants in the clinical trial were used. Plasma levels of SP-A and SP-D were measured at baseline and on day 3 after the start of the mechanical ventilation protocol. The longitudinal impact of baseline plasma surfactant protein levels on clinical outcomes was examined by multivariate analysis, controlling for mechanical ventilation group, APACHE III score, and other clinical covariates. The effect of 6 ml/kg tidal volume ventilation on plasma SP-A and SP-D levels was evaluated using analysis of covariance. RESULTS: Baseline plasma SP-A levels were not related to any clinical outcome. In contrast, higher baseline plasma SP-D levels were associated with a greater risk of death (OR 1.21 per 100 ng/ml increment; 95% CI 1.08 to 1.35), fewer ventilator-free days (mean decrease -0.88 days; p=0.001), and fewer organ failure-free days (mean decrease -1.06 days; p<0.0001). The 6 ml/kg tidal volume strategy had no effect on the rise in plasma SP-A levels (p=0.91) but attenuated the rise in plasma SP-D levels (p=0.0006). CONCLUSIONS: Early in the course of ALI/ARDS an increased level of plasma SP-D is associated with a worse clinical outcome. The 6 ml/kg tidal volume strategy attenuated the rise of SP-D early in the clinical course. Taken together, these observations indicate that plasma SP-D, a product of alveolar type II cells, is a valuable biomarker in ALI/ARDS.

Enzyme-Linked Immunosorbent Assay↗
PubMed2001

Is patients' perception of time spent with the physician a determinant of ambulatory patient satisfaction?

BACKGROUND: Time management in ambulatory patient visits is increasingly critical. Do patients who perceive a longer visit with internists report increased satisfaction? METHODS: Prospective survey of 1486 consecutively encountered ambulatory visits to 16 primary care physicians (PCPs) in an academic primary care clinic. Patients were queried regarding demographics, health status, perception of time spent before and after ambulatory visits, whether the physician appeared rushed, and visit satisfaction. Physicians were queried regarding time spent, estimated patient satisfaction, and whether they felt rushed. RESULTS: In 69% of 1486 consecutive visits, patient previsit expectation of visit duration was 20 minutes or less. Patient and PCP postvisit estimates of time spent significantly exceeded patient previsit time expectation. Patients who estimated that they spent more time than expected with the PCP were significantly more satisfied with the visit. When patient postvisit estimate of time spent was less than the previsit expectation, visit satisfaction was significantly lower independent of time spent. Patient worry about health and lower self-perceived health status were significantly associated with patient expectation for longer visits. Primary care physicians felt rushed in 10% of encounters. Although PCPs estimated patient satisfaction was significantly lower when they felt rushed, patient satisfaction was identical when PCPs did and did not feel rushed. Patients indicated that PCPs appeared rushed in 3% of encounters, but this perception did not affect patient satisfaction. CONCLUSION: Perceived ambulatory visit duration and meeting or exceeding patient expectation of time needed to be spent with the physician are determinants of patient satisfaction in an ambulatory internal medicine practice.

Ambulatory Care↗
PubMed2000

Seasonal patterns of LH, testosterone and semen quality in the Northern pintail duck (Anas acuta).

This study characterized seasonal changes in circulating LH and testosterone and in semen production and quality in the Northern pintail duck. Plasma LH and testosterone were measured in blood samples collected weekly throughout the year from eight males exposed to natural fluctuations in day length and temperature. Semen quality was evaluated weekly in these same males from April-June, the months when spermatozoa were produced. Semen quality (based on sperm concentration and normal morphology) peaked 0-2 weeks after sperm production onset and decreased sharply before sperm production cessation in late June. Nadir LH concentrations were measured in July and August with peak LH observed in May and November. There were clear seasonal patterns in circulating testosterone with July-September values being less (P<0.05) than October-December which, in turn, were less (P<0.05) than January-March. Maximal circulating testosterone (P<0.05) occurred during April-June, coincident with semen production. Weekly circulating LH during the breeding season was directly related to testosterone concentrations (P<0.01), but was not correlated to any specific semen or sperm trait (P>0.05). Testosterone concentrations throughout the breeding season were correlated (P<0.05) to total numbers of spermatozoa produced (volume x cell concentration) and percent normal sperm morphology. In summary, the Northern pintail experiences seasonal hormone fluctuations, with maximum circulating testosterone coinciding with peak ejaculate quality reflected by the production of high numbers of morphologically normal spermatozoa.

Animals↗
PubMed2000

Alternative/complementary medicine: wider usage than generally appreciated.

OBJECTIVE: To test the hypothesis that there is substantial use of a practitioner of alternative/complementary medicine by patients traditionally considered to be underserved. DESIGN: Cross-sectional, self-administered survey study. SETTINGS: Three university hospital-affiliated general ambulatory clinics serving patients of different socioeconomic status and racial origin. SUBJECTS: Five hundred and thirty-six (93% of those attending) consecutive clinic attendees. OUTCOME MEASURES: Past use and desired future use of one or more practitioners of five modalities of alternative/complementary medicine and willingness to pay for these modalities out-of-pocket. RESULTS: Past usage and desired future usage of one or more practitioners of alternative/complementary medicine was comparable at the three clinic sites despite wide differences in socioeconomic status and willingness/ability to pay out-of-pocket for these services. Multivariable analyses revealed lower self-rated health status and female gender (both p < 0.006) but not income, race, age or education as independent, significant predictors of use of a practitioner of alternative/complementary medicine. CONCLUSION: Usage of alternative/complementary medicine is not confined to any well-circumscribed socioeconomic group and is common in patients often considered to be underserved. Self-assessed lower health status is significantly and independently associated with use of a practitioner of alternative/complementary care.

Adolescent↗
PubMed2000

Anesthesia in female white-tailed deer using Telazol and xylazine.

Thirty two free-ranging female white-tailed deer (Odocoileus virginianus) were anesthesized with varying Telazol and xylazine HCl combinations in Front Royal (Virginia, USA) between August 1992 and September 1992. All animals were caught in baited box traps, manually restrained, and hand injected with a combination of Telazol and xylazine administered intramuscularly. Deer received mean +/- SE dosages of 2.53+/-0.16 mg/kg Telazol and 0.69+/-0.05 mg/kg of xylazine. These dosages achieved a rapid and effective anesthetic plane for short-term procedures such as weighing, blood collection, and translocation. Eight of 32 deer (25%) required an intravenous (i.v.) supplement of ketamine HCl (100 mg) to maintain a safe plane of anesthesia. Ketamine supplementation provided an average of 11.8+/-2.0 min additional safe handling. Satisfactory reversals were achieved in all deer by administering yohimbine HCl 16 mg i.v. (dose range, 0.22 to 0.48 mg/kg) to all animals.

Adrenergic alpha-Agonists↗
PubMed1997

The development and validation of the Children's Hope Scale.

Assuming that children are goal-oriented, it is suggested that their thoughts are related to two components--agency and pathways. Agency thoughts reflect the perception that children can initiate and sustain action toward a desired goal; pathways thoughts reflect the children's perceived capability to produce routes to those goals. Hope reflects the combination of agentic and pathways thinking toward goals. A six-item dispositional self-report index called the Children's Hope Scale is introduced and validated for use with children ages 8-16. Results suggest that the scale evidence internal consistency, and is relatively stable over retesting. Additionally, the scale exhibits convergent, discriminant, and incremental validity. Limitations and uses of the scale are discussed.

Adolescent↗
PubMed1992

The use of diarrhoeal management counselling cards for community health volunteer training in Indonesia: the HealthCom Project.

The Indonesian Ministry of Health relies on a network of over a million kader (community health volunteers) to bring primary health care to the village level. In West Java, the Department of Health's Control of Diarrhoeal Disease (CDD) Program recently carried out an extensive research and development effort to produce effective job aids for the kader in CDD and a training programme to teach their use. A set of counselling cards was produced to provide kader with a tool to diagnose and treat diarrhoea and teach the proper use of ORS. Researchers conducted a controlled evaluation in which they measured the cards' effectiveness through observations of kader performance and interviews with mothers they had counselled. In the intervention group, 15 kader underwent two days training in the use of the cards when diagnosing and advising treatment for cases of diarrhoea in their villages. The 16 control kader received comparable CDD training without the cards. Each group provided lists of local mothers they pledged to counsel during the coming weeks. Follow-up interviews were held with these mothers to test their level of knowledge on CDD and to observe their ability to mix ORS properly. Significant performance differences between the intervention kader and mothers, and the control kader and mothers, were demonstrated. The intervention kader were consistently more accurate in their diagnoses and recommendations for treatment with a mean of 83% accuracy vs 68% for the control kader. Mothers counselled by the intervention kader also prepared ORS significantly better than the mothers counselled by the control kader, with 97 vs 74% accuracy.

Community Health Services↗
PubMed1990

Effects of cadmium and mercury on Na(+)-K+, ATPase and uptake of 3H-dopamine in rat brain synaptosomes.

Effects in vivo of cadmium (Cd), mercury (Hg) and methylmercury (CH3Hg) on Na(+)-K+ ATPase and uptake of 3H-dopamine (DA) in rat brain synaptosomes were studied. These heavy metals significantly inhibited the Na(+)-K+ ATPase activity in a dose-dependent manner. Similarly, inhibition of DA uptake by synaptosomes was also observed in rats treated with these metals. Intraperitoneal route of metal administration was found to be more effective than per os treatment. Mercuric compounds compared to Cd elicited a higher inhibition of Na(+)-K+ ATPase and DA uptake in rat brain synaptosomes.

Animals↗
PubMedDate not supplied

Validity and reliability of the dexter hand evaluation and therapy system in hand-injured patients.

This study compares measurements obtained using the Dexter Hand Evaluation and Therapy System with those obtained using manual goniometers and grip and pinch dynamometers. Intrarater and inter-rater reliabilities for each tool were also examined. Repeated digit range of motion and strength measurements were performed on 30 subjects who had prior upper extremity injuries. Three therapists performed all measurements on each subject three times, using both Dexter and manual instruments. Analyses of variance (ANOVAs) and intraclass correlation coefficients (ICCs) were used to assess concurrent validity and therapist reliability. The findings show that the computerized Dexter finger goniometer and grip and pinch dynamometers provide measurements that are statistically similar to those of their manual counterparts. The ANOVA results for concurrent validity showed no significant differences between mean measurement values across therapists for the Dexter tools compared with the manual tools (p> or =0.54). In addition, no significant differences were found among or between the therapists' measurements. The range of ICCs for intrarater and inter-rater reliability for all four tests was 0.86 to 0.99. However, a two-way ANOVA revealed a therapist effect during pinch strength measurements (p< or =0.05), suggesting the need for same-therapist and same-tool measurements until the Dexter pinch dynamometer has been further evaluated.

Adult↗
PubMedDate not supplied

The 1998 Clinical Research Award. Sleep disturbance after burn injury: a frequent yet understudied complication.

This study investigated the frequency of sleep disturbance of burn survivors at 3 time points: during hospitalization (time 1: n = 237), 1 week after discharge (time 2: n = 149), and 2 months after discharge (time 3: n = 91). Predictors of sleep disturbance and its relationship to quality of life are explored. Measures of sleep, post-traumatic stress disorder, depression, anxiety, pain, and quality of life were administered at each time point. Fifty percent of participants had sleep disturbance while in the hospital and 1 week after discharge. Forty percent of participants continued to have sleep disturbance 2 months after discharge. In regression equations, emotional distress was a better predictor of sleep disturbance than pain and total body surface area burned at each time point. Sleep disturbance was significantly negatively correlated with all aspects of quality of life represented on the SF-36 Health Survey. Sleep disturbance is a common and often chronic postburn complication that warrants further research.

Adult↗
PubMedDate not supplied

Effect of early body image dissatisfaction on subsequent psychological and physical adjustment after disfiguring injury.

OBJECTIVE: The impact of body image dissatisfaction on quality of life after severe burn injury was investigated after controlling for other determinants of outcome (i.e., injury, distress, and preburn quality of life). METHODS: The postburn quality of life (2-months postdischarge) of groups with and without body image dissatisfaction was studied after controlling for preburn quality of life (measured 2-3 days postadmission). The patient population (N = 86) was 77.9% men, had an average total body surface area burned of 17.02%, and average full-thickness burn of 6.09%. Forty percent had facial injuries, 68.6% required surgery, most were injured by flame (39.5%), and 76.8% were employed. RESULTS: Multivariate analysis of covariance (covarying preburn level of Mental quality of life, facial injury, and size of burn) contrasting body image dissatisfaction groups found significantly lower psychosocial adjustment at 2-month follow-up in those with greater body image dissatisfaction (multivariate F = 3.61; p<.01). A second MANCOVA (covarying the preburn level of Physical quality of life and both facial injury and size of burn) found significantly lower physical functioning at 2-month follow-up in those with greater body image dissatisfaction (multivariate F = 2.78; p < .03). Adding two more covariates (depression and posttrauma distress) eliminated the effect of body image dissatisfaction on postburn Physical but not Mental adjustment. CONCLUSIONS: Body image dissatisfaction affects quality of life after severe burn injury. Distress moderates this impact on aspects of physical but not psychosocial health.

Adaptation, Psychological↗