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Biomedical subjects

M Darby

Publications and source records attributed to M Darby.

At least 19 recordsLinked to original sources
PubMed2000

Pediatric renal transplantation in the Netherlands.

In the Netherlands, pediatric kidney transplantation programs are available in four centers. We retrospectively analyzed the results obtained over the past decade. Between 1985 and 1995, 231 patients (139 boys) received 269 transplants, including 61 repeat. The recipients were aged 1.9-21.8 yrs (mean 10.9), the donors 0.3-63.3 yrs (median 11.4, mean 19.7). Immunosuppression consisted of corticosteroids, cyclosporin A and azathioprine, in various combinations and dosages. The patient survival during follow-up was 97%. The overall graft survival was 73% at 1 yr and 60% at 5 yrs after transplantation. Major causes of graft loss were acute rejection (21%), thrombosis (12%) and chronic rejection (28%). Acute rejection episodes were noted in 74% of all grafts. First acute rejection episodes had a moderate predictive value for graft loss (relative risk (RR), compared to rejection-free grafts, 5.9). First rejection episodes occurring later than 3 months after transplantation were considerably more predictive (RR 18.3) than early ones. Grafts from living related donors (n = 35) yielded a superior 5-yr graft survival (77%) and remained free of rejection more often than grafts from adult cadaveric donors(43% vs. 25%). The results of pre-emptive transplants were excellent (n = 13, 5-yr survival 100%). Repeat transplants had the same results as primary transplants. Recipients younger than 4 yrs showed a poor 5-yr graft survival of 38% (n = 13). Single kidney grafts from donors younger than 4 yrs (n = 35) had a 5-yr graft survival of 44%. In contrast, kidneys from these young donors did well if transplanted en bloc (n = 10, 5-yr graft survival 89%). These overall results are in line with those of others. The results may be improved by expansion of immunosuppressive therapy in the first year and by thrombosis prophylaxis in high-risk patient-donor combinations. Better results may be expected from more extensive use of living related donations, pre-emptive transplantation and en bloc transplantation instead of single kidneys of young donors.

Adolescent↗
PubMed2000

Sexual harassment in dentistry: experiences of Virginia dental hygienists.

PURPOSE: The purpose of this study was to determine if dental hygienists in the Commonwealth of Virginia experienced sexual harassment while employed in oral health care settings. Other interests were to determine if dental hygienists experienced sexual harassment, to what extent they felt professionally prepared to respond to unwanted sexual behaviors; did they perceive sexual harassment as a problem in the oral health care environment; and was attrition from their employment associated with sexual harassment. METHODS: A questionnaire, Sexual Harassment in the Dental Hygiene Profession, designed by the author, was used in this research. A list of currently licensed and registered dental hygienists was obtained from the Virginia Board of Dental Examiners and the questionnaire was sent to 540 randomly selected registered Virginia dental hygienists. Two weeks after the initial mailing, a second questionnaire was sent to non-respondents. The survey elicited data on experience, management, and personal opinions relative to sexual harassment, as well as demographic information. Results were analyzed using frequencies, percentages, and the chi-square test of association. RESULTS: Two hundred eighty-five surveys (53%) were returned and useable. Findings revealed that 54% of the responding dental hygienists experienced sexual harassment. Of these, 50% experienced sexual harassment four or more years ago, 23% one to three years ago and 28% within the last year; these categories were mutually exclusive. The perpetrators of the harassment were reported to be either male dentists (73%) or male clients (45%). Less than 10% reported being harassed by women. While 70% of the sexually harassed respondents indicated that filing formal complaints was an effective strategy for managing sexual harassment, less than 1% actually did so. Of all dental hygienists (harassed or not), 90% did not receive training in their dental education to manage sexual harassment, and 85% would like the American Dental Hygienists' Association to develop model guidelines and policies. Demographic characteristics were typical of practicing dental hygienists in Virginia; 99% female, 96% Caucasian, and 86% married with a mean age of 40 years. CONCLUSION: Information about managing sexual harassment needs to be incorporated into the dental hygiene curricula. This curriculum addition should include information on identifying sexual harassment incidents, strategies for controlling unacceptable behavior, the legal rights of employees, and the process of filing a formal complaint. Dental hygienists need to identify sexual harassment behaviors and receive prevention training though continuing education courses. Furthermore, the American Dental Hygienists Association and the American Dental Association need to collaboratively develop guidelines and policies for dentists and dental hygienists regarding the management of sexual harassment in the oral health care setting.

Adult↗
PubMed1999

Comparison of 2D conventional, 3D conformal, and intensity-modulated treatment planning techniques for patients with prostate cancer with regard to target-dose homogeneity and dose to critical, uninvolved structures.

The purpose of this study was to compare 2-dimensional (2D), 3-dimensional (3D) and intensity-modulated radiation therapy (IMRT) techniques for external-beam radiation treatment for prostate cancer. Dose homogeneity within the target volume and doses to critical, uninvolved anatomic structures were evaluated. Computed tomography (CT) scans of 3 patients with localized prostate cancer (T2NOM0) were acquired and transferred to the treatment planning systems. The target volume and uninvolved structures were contoured on axial CT slices throughout the volume of interest. A comparison of the 3 treatment techniques was performed using isodose distributions, dose statistics, and dose-volume histograms. Dose homogeneity was found to be most uniform with the 2D technique; however, the 2D technique delivers unnecessary radiation doses to the rectum and bladder. The dose conformity observed with IMRT is increased compared with that observed with the 3D technique, as is the sparing of critical uninvolved structures; however, dose homogeneity appears to be worse with IMRT than with the 3D technique. Overall, of the 3 techniques, IMRT offers the most conformity in delivery of tumoricidal doses to the prostate while sparing dose to critical, uninvolved structures. Association of Medical Dosimetrists.

Femur Head↗
PubMed1999

Optimal staffing for hospitals: in search of solutions.

The best staffing models are those that give nurses and other caregivers control and flexibility in their work, say administrators who are fighting higher acuity, tighter budgets and shorter patient stays as well as the threat of staff burnout. Specialty float pools, well-trained students and carefully defined job charters all can ease the strain, staffing experts say.

Efficiency, Organizational↗
PubMed1999

Coordinating care in an integrated delivery system.

To keep patients from falling through the cracks, each point of service in a healthcare system must understand its role in the patient's overall care and have access to the right information at the right time. Communication and a system's organization play significant roles in making coordinated care work: Some health systems prefer to keep patients with common diagnoses in service lines that take them from preadmission to home care; others set up separate organizational entities to coordinate care for all patients with chronic illness. Regular meetings on patient status, standardized forms and clear job descriptions all help minimize confusion.

Case Management↗
PubMed1998

Health care quality: from data to accountability.

The many audiences for information about the quality of health care have different and sometimes conflicting interests and priorities. This is reflected in the diversity of current efforts to use health care data to identify, measure, and demonstrate quality. The author surveys three of these approaches in depth: (1) the professional approach, which relies on the actions of private-sector accreditation groups, trade associations and health plans, hospitals, and other providers to assure quality; (2) the market-driven approach, which relies on the use of quality data by health care purchasers and consumers in choosing plans and providers; and (3) the public-sector approach, which relies on the regulatory, oversight, and purchasing actions of government at the federal, state, and local levels to assure quality. The author concludes that efforts to measure and report the quality of health care invariably confront a variety of technical and political issues. Several observers maintain that it is more important for participants in quality issues to reach consensus on the issues than to reach technical perfection in the way the data are handled. Important obstacles in the technical realm include inadequate investment in sufficiently sophisticated and compatible information systems and the fact that where such systems are in place, they generally cannot be linked. But efforts, both technical and legal, are under way to overcome these obstacles. Even so, some of the issues of health care quality will remain moving targets because of constant changes in the health care environment and in technology. The author closes with the hope that the various actors within the health care industry may coordinate their efforts in dealing with these issues.

Accreditation↗
PubMed1998

Making the most of data for disease management.

Managed care organizations have a wealth of administrative, claims and clinical data available to them--data that could pinpoint patients who could benefit from cost-effective disease management programs. Health plans that have such efforts offer advice on how to home in on the best data.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1997

Use of thermoluminescent dosimetry to verify dose compensation in total body irradiation.

For Total Body Irradiation (TBI) the midline dose along the long axis of the body should vary by no more than +/- 10% compared to the dose received at the prescription point. Compensating filters are often made to compensate for contour irregularities. This paper describes an experimental method using Thermoluminescent Dosimetry (TLD) to verify the appropriateness of dose compensation provided by compensating filters. An AP/PA treatment geometry was used with an 18 MV photon beam. TLDs were placed in the midplane and on the surface of an anthropomorphic phantom in five different areas. Three different lead compensating filters were designed to provide proper compensation, overcompensation, and undercompensation. The TLD readings were compared with calculated doses and the measurements correlated favorably. The measurements were sensitive enough to detect dose variations due to improper compensation. These results demonstrate that TLD is a reliable method of verifying dose compensation provided by compensating filters in TBI.

Humans↗
PubMed1997

Health status assessment--a vital sign for planning patient therapy.

To better understand patient problems, some physicians are gathering and evaluating data on patients' perceptions of their health and emotional strengths. The tool--the SF-36 or Health Status Questionnaire--can be incorporated into practice with a small investment in technology and a few minutes with the patient.

Health Resources↗
PubMed1995

The use of ultrasound for monitoring breast tumour response to pro-adjuvant therapy.

In a prospective study, use of serial ultrasound (US) for monitoring tumour response to pro-adjuvant chemotherapy was assessed in 16 patients. Comparison was made with mammographic and pathological tumour size measurements. Clinical and radiological response to treatment was assessed using UICC (International Union Against Cancer) criteria. Comparison of clinical and US response to treatment showed some agreement in 60% and disagreement in 40%. This was comparable with clinical versus mammographic responses (55% and 45%). Correlation between calliper and pathological measurement was similar to that between US and pathological measurement (r = 0.51, P = 0.05; r = 0.50, P < 0.05). Mammography showed poorer correlation (NS). For assessment of final tumour size, US clinical measurements were comparable and better than mammography. US may be a useful tool in monitoring the response of breast tumours to pro-adjuvant therapy.

Adult↗