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Biomedical subjects

M Bullock

Publications and source records attributed to M Bullock.

17 recordsLinked to original sources
PubMed1999

Anaesthetic assistants: their role in the development and resolution of anaesthetic incidents.

Trained anaesthetic assistants are considered essential for the safe conduct of anaesthesia. Data from 5837 AIMS (Anaesthetic Incident Monitoring Study) reports were evaluated for issues concerning anaesthetic assistants in the generation and resolution of anaesthetic incidents. "Inadequate assistance" as a contributing factor was identified in 187 reports, whilst "skilled assistance" which minimized the incident was present in 808 cases. One hundred and seventy-two reports specifically commented on anaesthetic assistants in the narrative section of the AIMS form. All surgical specialties were represented. In 147 of these reports the assistant actually contributed to or failed to assist with the incident. Although the majority of outcomes from the reports were uneventful, prolonged stay, awareness and ICU admission did ensue in a small number of cases. The most common incidents were related to problems with equipment, communication and inadequate staffing levels (number and/or skill mix). Results from this study have implications for anaesthetic assistant staffing levels and the orientation of course content.

Anesthesia↗
PubMed1989

Suppression of human peripheral blood mononuclear cell function by methadone and morphine.

Recent studies have shown that in vitro exposure of peripheral blood mononuclear cells (PBMC) to morphine results in suppressed respiratory-burst activity of monocytes and impaired interferon-gamma (IFN-gamma) production by lymphocytes. To investigate the potential in vivo effect of an opiate on these cell functions, PBMC were obtained from patients maintained on methadone. These freshly isolated mononuclear cells had a significantly impaired capacity to generate superoxide anion (O2-) in response to phorbol myristate acetate (PMA), while production of IFN-gamma by concanavalin A-stimulated cells was intact. After cell culture for 48 h, the defective O2- generating capacity was sustained. Also, culturing PBMC from healthy controls in the presence of methadone or morphine at concentrations as low as 10(-12) M caused significant suppression of PMA-stimulated O2- release. Because reactive oxygen intermediates produced by PBMC may participate in host defense against opportunistic pathogens in AIDS, these results underscore the need for investigations of the biological consequences of opiate-mediated immunosuppression.

Adult↗
PubMed1989

Development of a health questionnaire specific for end-stage renal disease.

To compare the efficacy of various end-stage renal disease (ESRD) therapies valid and reproducible probes which measure well-being and are specific for ESRD are necessary. Four studies were undertaken to provide and test these probes. (1) 107 dialysis and 119 transplant recipients were interviewed to determine the prevalence of 24 physical symptoms. (2) A questionnaire was devised using 2 new indexes (a symptom scale derived from the first study using 12 symptoms and an affect scale comprising 12 emotions) and 6 indexes previously used in other chronic illnesses. Interobserver and intraobserver reproducibility was satisfactory. (3) Construct validity for the questionnaire was shown by interviewing 97 dialysis and 82 transplant patients in whom we hypothesized that physical well-being would be better in transplant patients. After age matching the transplant group was more active, with a higher objective quality of life and fewer physical symptoms than the dialysis group. (4) 63 stable dialysis, 67 stable transplant, 15 dialysis patients successfully transplanted in the intervening year and 5 failed transplanted patients were reinterviewed 1 year later to assess the responsiveness of the questionnaire. In the group who had recently been successfully transplanted both physical, affect and quality of life scores showed a major improvement following transplant. We conclude that this questionnaire is specific for ESRD, examines physical, psychological, and social well-being, is brief, easily administered, reproducible, has construct validity and is responsive to changes in therapy.

Adult↗
PubMed1988

Clinical features and severity of nonspecific symptoms in dialysis patients.

Nonspecific symptoms are common in dialysis patients but few methods are available to measure their severity and their response to alteration in dialysis therapy. To determine the clinical features and measure the severity of the most important symptoms in end-stage renal disease (ESRD) patients, 97 dialysis patients were interviewed, 63 of whom were reinterviewed 1 year later. For comparison 82 transplant recipients were also interviewed. The six most important symptoms in dialysis patients (using the product of the patient's perception of severity and prevalence) were tiredness, cramps, pruritus, dyspnea, headaches and joint pain. The symptoms were long-standing, occurred frequently, with little difference in prevalence between hemo- and peritoneal dialysis patients, and were often unrelated to a hemodialysis session. For each symptom, several dimensions of severity were assessed including frequency, duration, effect on sleep, daily living, activity, subjective quality of life and necessity for drug therapy. Often these dimensions did not correlate with patient's perception of severity. For each symptom these items were combined to give an aggregate score with a range 0-10. Interobserver reproducibility for each symptom score was greater than or equal to 0.7 but intraobserver reproducibility was poor for 3 symptoms, because of the fluctuating nature of the symptoms. Construct validity was demonstrated by finding a significantly worse distribution of aggregate scores for tiredness, cramps, pruritus, dyspnea and nausea/vomiting in dialysis compared to transplant patients. Aggregate scores changed little after 1 year's follow-up in stable dialysis patients but significant improvement in the aggregate scores for tiredness, dyspnea and nausea/vomiting were observed in 14 patients after successful transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude to Health↗
PubMed1988

The development of volitional behavior in the toddler years.

In order to generate a description of early volitional skills, toddlers' abilities to match their activities to externally defined task standards and to monitor and control activities with respect to outcomes were studied. Children between 15 and 35 months were observed as they engaged in a series of play and clean-up tasks. The results showed that there is a consistent developmental pattern in the extent to which children focus on producing outcomes (rather than on acting for its own sake), the extent to which they monitor, correct, and control activities, and the frequency with which they react to their outcomes with positive affect. These patterns are interpreted in terms of changes in the representation of actions, self-regulation abilities, and the active involvement of the self in actions.

Affect↗
PubMed1981

The functional and social significance of orthopedic rehabilitation of mentally retarded patients with cerebral palsy.

The 14 outpatients transferred for surgery on the hips and legs also made significant gains, primarily in hygiene and sitting tolerance. Unfortunately, they required two to four times the period of hospitalization of similarly involved nonretarded children. This is an important consideration in the outpatient group, perhaps less so in the previously institutionalized child. In the entire group of patients, including those followed for less than five years, we have had three deaths. Two were due to pneumonia, two months and four months after the hip procedure. One was due to osteosarcoma of the operated femur four years postoperatively.

Adolescent↗
PubMed1981

The grief-relief process: coping with the life and death of physically and mentally disabled children.

Many parents of children with severe physical and mental deficits appear to be in conflict between two ambivalent emotions, wanting to live with their child and needing to be relieved from their child's constant suffering. This internal struggle may become a life-long "grief-relief process" for the parents that is manageable but unresolved. The emotional conflict may result in a subconscious or conscious death wish for the child. The conflict reaches its peak when etiology, surgery, and prognosis are discussed and when the child dies. It has been noted that with the death of the child there may be a rapid movement from grief to a sense of relief. This has been referred to as the "grief-relief phenomenon." Though relief appears soon, the period of bereavement may be long and painful. Consequently, the importance of long-term follow-up has been emphasized. Practical suggestions have been offered to allied health professionals working with these parents on a daily basis. This article has concerned itself primarily with the emotional adjustment of parents to children with severe deficits. The grief-relief phenomenon may also be applicable in relation to other populations, such as elderly or terminally ill patients who are constantly in pain and suffering.

Adult↗
PubMed1980

Preschoolers' understanding of simple object transformations.

The ability of 3- and 4-year-old children to reason about the components of event sequences involving simple transformations was tested in 2 experiments. In Experient I children saw picture "stories" of the form object, instrument, and transformed object, with 1 item deleted. They filled in the missing position from 3 choice cards. Children in both groups correctly filled in all positions and therefore could: (1) predict the transformed state of an object, (2) retrieve the initial state of an object, and (3) understand the implicit actions that mediate 2 object states. This was true for transformations that (1) either altered or restored an object, and (2) represented familiar or unusual events. In Experiment II only the instrument item was deleted. Children demonstrated an ability to represent reciprocal transformations (e.g., break-fix); they chose the 2 of 4 instruments that altered and restored the same object. The younger children were less able to describe the events and found it somewhat easier to reason about transformations that altered objects.

Child, Preschool↗
PubMedDate not supplied

Reiki: a complementary therapy for life.

Tom was diagnosed with a very aggressive cancer and received only palliative radiation and medication. At the time of diagnosis, his symptoms suggested that he had a very limited life expectancy. With the Reiki and his intent, he was able to achieve his goal of long-term stability with freedom from immobilizing pain and swelling. Tom's comfort and quality of life improved dramatically, and he is living well with his cancer. Reiki has been associated with dramatic results for many patients. The importance of the patient's intent during Reiki treatments cannot be overemphasized. Some general trends seen with Reiki include: periods of stabilization in which there is time to enjoy the last days of one's life; a peaceful and calm passing if death is imminent; and relief from pain, anxiety, dyspnea and edema. Reiki is a valuable complement in supporting patients in their end-of-life journey, enhancing the quality of their remaining days.

Aged↗