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Biomedical subjects

M Joffe

Publications and source records attributed to M Joffe.

At least 73 records · Page 4Linked to original sources
PubMed1992

Effect of educational program on compliance with glove use in a pediatric emergency department.

OBJECTIVE: To investigate the effect of an educational program on compliance with glove use in a pediatric emergency department. DESIGN: Without their knowledge, participants were observed for routine use of gloves during vascular access procedures before and after an educational program. Participants with up to 3 years' vascular access experience were defined as less experienced and those with 4 or more years' experience were defined as more experienced. Their success rates performing vascular access procedures with and without wearing gloves were also monitored. SETTING: Inner-city pediatric hospital emergency department. PARTICIPANTS: Twenty-three emergency department registered nurses. INTERVENTIONS: A 30-minute lecture with slides, written materials, and posters addressing the reasons and need for universal precautions, and recommended methods of barrier precautions to prevent skin and mucous membrane exposure when handling sharp instruments. MEASUREMENTS/MAIN RESULTS: For the less experienced registered nurses, the compliance rate before the educational program was 70% and remained at about 93% afterward. For the more experienced registered nurses, the compliance rate before the program was only 15%. After the program, this compliance rate rose to 93%, but declined to only 50% by the fifth month. The registered nurses' success rate on the first attempt at vascular access while wearing gloves was 75% compared with 70% without gloves. CONCLUSION: Educational programs can result in a clinically significant increase in glove use by pediatric emergency department registered nurses. Long-term improvement was less pronounced for the group of more experienced registered nurses. We also observed that glove use does not appear to interfere with the proficient performance of vascular access procedures.

Bloodletting↗
PubMed1992

Follow-up of patients with occult bacteremia in pediatric emergency departments.

Blood cultures are frequently obtained in pediatric emergency departments (EDs) from febrile young children at risk for bacteremia and subsequent development of serious bacterial infections. This study of 105 children with occult bacteremia treated in two large urban pediatric EDs describes the follow-up of these patients and the impact that positive blood culture results have on the detection of serious illness. Seventy-seven percent of patients had a follow-up visit in the ED, 8% had follow-up by telephone alone, and 15% were not contacted. Of the patients who returned to the ED, 49% did so because they were notified of the positive blood culture result. The mean time interval for these patients from registration at the initial visit to report of positive blood culture result was 30.0 hours and, from registration at the initial visit to follow-up visit, was 42.7 hours. Thirty-seven percent of those who returned did so because a follow-up visit was scheduled at the initial encounter, and 13% returned because of persistent illness. Ten children (9.6%), five of whom had been notified of the positive blood culture, returned with serious illnesses. Patients whose diagnosis of serious illness was facilitated by blood culture results had shorter delay in identifying cultures as positive than did patients notified of positive results who did not develop serious illness (16.2 vs 31.6 hours; P < 0.05). The delay in follow-up of children with occult bacteremia limits the usefulness of blood cultures in the early detection of serious illness.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacteremia↗
PubMed1992

Epidemiology of occupational reproductive hazards: methodological aspects.

Both male and female workers may be exposed to occupational agents which affect their reproductive processes. Reproductive outcomes are important in their own right, for example teratogenic effects and impaired neurological development. In addition, reproductive impairment may indicate germ cell mutation, which has far-reaching implications. Research into reproductive effects is beset with pitfalls. Applying the results of toxicological research may be suggestive, but such extrapolation is very unreliable owing to profound differences in reproductive and/or toxicological mechanisms. Epidemiological data are therefore indispensable. Optimal methods of data collection and study design, comparable with similar studies of other populations, are essential. Otherwise reliable conclusions cannot be drawn, and this is a waste of resources and of the work and cooperation of everyone who participates in the research. In considering study design, the key question is the measurement (or minimally, the accurate description) of exposures, which is more problematic than the ascertainment of reproductive outcome variables. From the viewpoint of exposures, case control studies have the same disadvantage as studies of the general population, that exposures are heterogeneous, and most specific exposures are therefore rare, even in a large study; in addition, measurement is particularly difficult in this situation. Occupationally defined populations have the corresponding advantages of relative homogeneity and availability of data, although even here numerous problems exist, which are well known. Outcomes can be assessed by means of biological or questionnaire-based methods. They are best regarded as complementary, as each has its strengths and weaknesses.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormalities, Drug-Induced↗
PubMed1991

Kinase activity and protein phosphorylation in control and malignant hyperthermic skeletal muscle.

1. Native 6% Laemmli gels were used to resolve 7 protein kinase activity bands in control and malignant hyperthermia (MH)-susceptible porcine and human skeletal muscle extracts. 2. MH-susceptible samples were consistently more active than the controls. 3. Following halothane treatment, a 43 kDa component displayed increased phosphorylation by a calcium-calmodulin dependent kinase in MH-susceptible vs control human samples. 4. Increased phosphorylation of additional endogenous protein components of molecular mass 116 and 60 kDa was observed.

Animals↗
PubMed1991

Evaluating the quality of the maternity services--a discussion paper.

OBJECTIVE: A review of the use of computer collected audit data in assessing the quality of maternity services. SETTING: All maternity units managed by the North West Thames Regional Health Authority. RECOMMENDATIONS: A system of audit must supply information that is both credible and of interest to clinicians managers and consumers. The information should be adjusted for differences in populations to allow valid comparisons between units. It needs to be presented in an easily digested form. One way of implementing audit would be to establish a regional group representative of clinicians, patients and managers who would initially interpret the data and make recommendations. A local group of similar composition would be asked to comment on and respond to these with a plan for the following year. Changes would be monitored by analysis of the routinely collected data. CONCLUSIONS: Medical audit in the maternity services requires new concepts if it is to influence the quality of clinical care and the use of resources available to provide that care. The appropriate balance needs to be found between the perspectives of clinicians, patients and managers. A major challenge is the collection of valid data. This has largely been overcome by the St Mary's maternity information system. The next stage is to devise a system of audit that is epidemiologically sound and is acceptable to those who will be asked to implement the lessons that emerge. Only then will it be possible to determine whether clinical practice and the use of resources can be altered to the benefit of patients.

Data Collection↗
PubMed1991

Fire hydrant play: injuries and their prevention.

A total of 86 children treated for injuries that occurred while playing in water from fire hydrants are described. Patients were urban (100%), minority (97%) children with few alternative means for keeping cool. Injuries occurred on extremely hot summer days (mean maximum temperature 36.3 degrees C [97.5 degrees F]). Laceration of the foot on broken glass was the most common injury and was prevented by wearing footwear (P less than .001). Motor vehicles caused all serious injuries. Sprinkler attachments on the hydrants were associated with significantly fewer motor vehicle-related injuries (P less than .001) and water pressure-related injuries (P = .02). Adults were present at more than 90% of injury scenes, but had no effect on the safety of fire hydrant play. Public policy should be directed toward increasing the availability of alternative means for keeping cool, increasing the number of hydrants equipped with sprinklers, and reducing the amount of broken glass in the streets. Public education targeting adults to remove glass from the street, insist that children wear footwear, and open only those hydrants that have sprinklers could further reduce injuries to urban children who play in water from fire hydrants.

Adolescent↗
PubMed1990

Blasts in peripheral blood with intraosseous infusion.

Two children who died of apparent Sudden Infant Death syndrome (SIDS) were found to have immature white blood cells, including blasts, in their peripheral blood. No cause for marrow elements in peripheral blood was found. The blood was sampled proximal to an intraosseous infusion, which may have displaced the marrow elements into the venous circulation. Physicians should be aware that patients receiving intraosseous infusions may have immature white blood cells in the peripheral circulation in the absence of malignant, infectious, or infiltrative disease of the marrow.

Bone Marrow↗
PubMed1989

The usefulness of various polymorphisms in paternity testing. Experience with three southern African populations.

Genetic studies have been carried out on 1,059 cases (involving 3,177 blood samples) of disputed paternity. Seventeen polymorphic systems, representing 21 loci, have been used on all the cases and an additional 11 system (12 loci) were used when an exclusion on only one of the system was obtained. The overall rate of exclusion was 34.0% and the data were analysed according to the population from which the case came (white, 'coloured' or black). HLA is the most informative system in all three populations, followed by PGM1, with the rhesus blood group the next most useful in the whites and 'coloured's, whereas ABO is the next most useful in the blacks. The probability of excluding a man falsely accused of paternity was 99.1% in the black, 99.4% in the white and 99.7% in the 'coloured' populations. The data were also used to calculate the probability of paternity in the cases in which an exclusion could not be demonstrated; values of over 98% were found in 98.5% of whites, 98.8% of 'coloureds' and 90% of blacks; a further 9.1% of blacks gave values of 95.1 - 98.0%. The range of genetic markers, representing red cell antigen, red cell enzyme, serum protein and HLA polymorphisms used in this study, meets the requirements of an efficient paternity testing service.

Black People↗
PubMed1989

Social inequalities in low birth weight: timing of effects and selective mobility.

The risk of giving birth to a low birth weight baby is known to be associated with poor material circumstances during the mother's own childhood. In addition to this long-term effect, an association is also apparent of low birth weight with the mother's current social class, measured in terms of her husband's occupation. At least two interpretations of this are possible: a true short-term effect, and/or selective social mobility (upward or downward). According to the latter hypothesis, social class at marriage reflects the operation of selective social processes such that taller and better educated women tend to marry men of higher social class: because both attributes are negatively associated with the risk of low birth weight, a short-term effect is mimicked. This paper investigates the strength of this effect, using data from a longitudinal study, the National Child Development Study. The possibility is also explored that the social class gradients at different ages are not independent: for example that a beneficial socio-economic environment in early life can compensate for hardship later on, in terms of the risk of low birth weight, and vice versa. A social class gradient was observed in the proportion of low birth weight deliveries, both at the time of the respondent's own birth and at the time of her marriage. Depending on the assumption made concerning the relationship of height with low birth weight, selective mobility for height explained 10.7% or 16.3% of the apparent short-term gradient in low birth weight. Selective mobility for educational level did not have any effect. Further analyses suggested that having belonged to a higher social class either in early childhood or at marriage had a beneficial effect, notwithstanding the direction of any mobility experienced. The social class of the woman's father when she was 16 was not associated with the low birth weight rate, and upward mobility during the respondent's childhood appeared to carry an increased risk.

Body Height↗
PubMed1989

Medical student projects in practical health promotion.

This paper describes a programme of projects on health promotion policy carried out by students of St Mary's Hospital Medical School as part of the community medicine course. The programme of work draws together three themes which have recurred in recommendations on the future of medical education: the need to locate health within its social and economic context, the importance of training doctors in health promotion, and the educational value of project work. From a practical service perspective, the information gained thereby has been extremely valuable in assisting the development, implementation and monitoring of local health promotion policies.

Community Health Services↗
PubMed1989

Male- and female-mediated reproductive effects of occupation: the use of questionnaire methods.

Among methods of studying reproductive effects of occupational exposures, retrospective questionnaire-based surveys of occupationally defined populations have an important place. Reservations concerning the validity of such data have proved to be overstated. Recall is remarkably accurate for birthweight, gestational age, time taken to conceive, and phases of involuntary infertility, and this appears to hold for recall periods up to 20 years or more. Underreporting of miscarriages can be greatly reduced by restricting the analysis to those that have been confirmed both by a test and by a doctor. Interviews are preferable to self-completion format, as they tend to minimize response bias. It is important to consider many methodologic issues that arise in this type of research, such as the selection of confounding factors for inclusion in the questionnaire.

Birth Weight↗
PubMed1989

Feasibility of studying subfertility using retrospective self reports.

During an investigation of possible reproductive effects of environmental agents, 261 male and 155 female workers were interviewed concerning subfertility at some time in the past: the time taken to conceive, for all births; and the occurrence of one or more fertile phases lasting for 6 months or more. When these two variables were compared, the quality of reporting was acceptable in 89.7% of instances, and data editing enabled accuracy to be improved. Reporting was more reliable with shorter duration of recall, and female workers' reports were somewhat more reliable than those of male workers. The distribution of time taken to conceive was similar for male workers to that observed in previously published prospective series, though with a higher estimate of subfertility when infertile phases were also considered. Comparison with published estimates of reduced fertility appeared to be reassuring. As predicted, the equivalent comparisons for female workers showed the presence of a strong selection effect.

Data Collection↗