Creative arrangements benefit hospitals, home care agencies.
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Biomedical subjects
Publications and source records attributed to M Higgins.
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Fear and apprehension usually accompany surgery on the human heart. Experience and research have demonstrated that many patients who have undergone open heart surgery have less than optimal psychological outcomes. This article describes the response of one university hospital to the physiological and psychological needs of the cardiovascular surgery patient during the final phase of hospitalization. To give patients and families an opportunity to deal with their questions and concerns about discharge, one-sessional educational support groups are co-led by a social worker and cardiovascular nurse specialist. The development and implementation of patient and relative groups and the process through which a more comprehensive program evolved are described. An analysis of the experience and conclusions and recommendations for the future are reviewed.
Relationships between blood pressures (BPs) of young people and a number of personal, parental and familial characteristics have been assessed in the population of Tecumseh, Michigan. Systolic and fifth phase diastolic BPs were measured in 4500 persons under 20 years of age at the time of their first examination. Body size, fatness and heart rates of the subjects themselves were significantly related to their age- and sex-adjusted BP scores. The parents' BP scores were also correlated with those of the young subjects, and scores were significantly higher in those whose mothers had had high BP or toxemia in pregnancy of a stillbirth. A weak association between BP and socioeconomic circumstances was suggested by the slightly higher mean BP scores found in sons and daughters of men in blue collar jobs and of men and women with the least education. BP levels were not associated with birth order, sibship size or birth weight nor with the numbers of pregnancies, live births or abortions experienced by the mothers of young subjects. In a stepwise multiple regression, the most important determinants of BP were weight/height ratios of the subjects themselves and BP levels of their parents; a small additional effect of complications of pregnancy in the mother was detectable in the offspring 0--19 years laters.
Maximal oxygen uptake (Vo2max) was measured or estimated in 597 males, aged 16-69. Smoking and drinking habits were also determined in this population. After the influences of age, weight, skinfold thickness, and drinking habits were removed, smokers clearly had decreased Vo2max. Similarly, when the relationships were corrected for age, weight, skinfolds and smoking habits, the heaviest drinkers and the non-drinkers had the lowest, Vo2max and the moderate drinkers had the highest Vo2max, at least in the younger age groups. The same results were found when only those subjects in whom Vo2max was measured (essentially subjects under age 40) were included. Levels of habitual physical activity could not account for these differences.
The bone mineral content (BMC) of the lower end of the femur was measured by photon absorptiometry in 87 patients with chronic renal failure. The gamma-ray photon source was Am241. Serial measurements were obtained for up to two years. The mean BMC of the adult patients, comprising: 18 pre-dialysis (CRF), 41 chronic haemodialysis (CHD) and 19 renal transplant (RT) patients were all significantly lower than controls with the exception of the male CRF group. Two adults and one child on chronic haemodialysis showed a significant rate of bone loss (less than 2% per year). In one of these adults the addition of daily oral 1 alpha hydroxycholecalciferol was associated with no further reduction in BMC. Two children and one adult on chronic haemodialysis showed a significant rate of increase in BMC (less than 2% per year). This adult had had a tendency to loss of BMC on standard CHD treatment but after receiving parenteral 1,25 dihydroxycholecalciferol three times weekly showed a significant rate of loss of BMC on serial measurement. Two adults and one child with CRF had a significant rate of increase in BMC on standard treatment.
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Two male prison volunteers had severe cutaneous reactions to the initial patch testing of All-trans-retinoic acid containing products being evaluated for irritancy. Muliple patch testing procedures performed throughout one year, along with leukocyte migration inhibition studies, speak strongly for delayed hypersensitivity reactions in these subjects. The failure to document a previous exposure in subjects living in a controlled environment suggests that these responses were cross-reactions to a prior sensitizer, perhaps unique to this environment.
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The large industry which has grown up around the estimation of nursing requirements for a ward or for a hospital takes little account of variations in nursing skill; meanwhile nursing researchers tend to concentrate on the appropriate organisation of the nursing process to deliver best quality care. This paper, drawing on a Department of Health funded study, analyses the relation between skill mix of a group of nurses and the quality of care provided. Detailed data was collected on 15 wards at 7 sites on both the quality and outcome of care delivered by nurses of different grades, which allowed for analysis at several levels from a specific nurse-patient interaction to the shift sessions. The analysis shows a strong grade effect at the lowest level which is 'diluted' at each succeeding level of aggregation; there is also a strong ward effect at each of the lower levels of aggregation. The conclusion is simple; you pay for quality care.
Relationships between serum cholesterol and coronary heart disease (CHD) were investigated in Tecumseh men and women who were 45 to 92 years old and initially free of CHD. Recruitment continued through three cycles of examinations over a period of 10 years, beginning in 1959. Follow-up for mortality ended in 1986 to 1987. Age-adjusted relative risks for CHD death for cholesterol levels of 5.2 to 6.2 mmol/L and greater than 6.2 mmol/L, compared with levels less than 5.2 mmol/L for men aged 45 to 64 years, were 1.2 and 1.7; for older men they were 1.0 and 1.8. Comparable relative risks for CHD death by cholesterol level were .7 and 1.4 for 45- to 64-year-old women and .8 and .7 for older women. Coefficients for cholesterol were significant for fatal CHD in men under and those 65 years and older when age, systolic blood pressure, body mass index, cigarette smoking status, and glucose intolerance were controlled in proportional hazards models. Cholesterol was a significant predictor of fatal CHD plus nonfatal myocardial infarction in middle-aged, but not elderly women. Relative risks for total mortality were lowest for middle-aged men and women with cholesterol levels of 5.2 to 6.2 mmol/L and the difference was significant in men.
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In a prospective, randomized, double-blinded manner, we compared the effects of a preoperative intraarticular injection of morphine (5 mg) or a placebo, combined with a postoperative femoral nerve block, on postoperative pain. Sixty-two patients underwent an arthroscopically assisted anterior cruciate ligament reconstruction using patellar tendon autograft under general anesthesia. No statistical difference between the two groups was evident in terms of age, sex, weight, operative time, volume of bupivacaine received with the femoral nerve block, or tourniquet use or tourniquet time. Comparison of visual analog scale pain scores revealed no statistical difference between the groups at any point after the operation. Both groups had a significant decrease in visual analog scale scores after the femoral nerve block, with the lowest mean values 4 hours after the operation (morphine group, 1.7; placebo group, 1.4), and continuing to be significantly less through 24 hours (morphine, 2.6; placebo, 2.9). No significant difference in postoperative narcotic medication use was evident in the recovery room or at home. A post hoc power analysis revealed that the study power reached 87%, with a significance level of 5%. The postoperative femoral nerve block was effective, and intraarticular morphine provided no additional benefit.