Biomedical subjects
M Patrick
Publications and source records attributed to M Patrick.
Assault after ingestion of antidepressant.
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Costing nurse turnover in nursing homes.
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Malnutrition in children with chronic liver disease accepted for liver transplantation: clinical profile and effect on outcome.
The nutritional profiles of 37 children (aged 0.5-14.0 years) with chronic liver disease at the time of acceptance for orthotopic liver transplantation (OLTP) have been evaluated using clinical, biochemical and body composition methods. Nutritional progress while waiting for a donor has been related to outcome, whether transplanted or not. At the time of acceptance, most children were underweight (mean standard deviation (s.d.) weight = -1.4 +/- 0.2) and stunted (mean s.d. height = -2.2 +/- 0.4), had low serum albumin (27/35) and had reduced body fat and depleted body cell mass (measured by total body potassium--mean % expected for age = 58 +/- 5%, n = 15). Mean ad libitum nutrient intake was 63 +/- 5% of recommended daily intake (RDI). Those who died while waiting (n = 8) had significantly lower mean initial s.d. weight compared with those transplanted. The overall actuarial 1 year survival of those who were transplanted (mean waiting time = 75 days) was 81% but those who were initially well nourished (s.d. weight greater than -1.0) had an actuarial 1 year survival of 100%. There were no significant differences in actuarial survival in relationship to age, type of transplant (whole liver or segmental), liver biochemistry or the presence or absence of ascites. Of the total group accepted for OLTP, whether transplanted or not, the overall 1 year survival for those who were relatively well nourished was 88% and for those undernourished (initial s.d. weight less than -1.0) was 38% (P less than 0.003). Declining nutritional status during the waiting period also adversely affected outcome.(ABSTRACT TRUNCATED AT 250 WORDS)
Barbiturate-assisted interviews in modern clinical practice.
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Cyclosporin-responsive enteropathy and protracted diarrhea.
We describe a child born to unrelated parents who developed severe protracted secretory type diarrhea associated with subtotal villus atrophy and intestinal inflammation at the age of 19 months. No infectious, metabolic, or anatomical basis for this condition was identified and the child required total parenteral nutrition for a period of 18 months despite trials of special enteral formulas, steroids, and anti-inflammatory agents. This refractory "enteropathy" responded dramatically to the introduction of cyclosporin, with cessation of the secretory diarrhea, recovery from the enteropathy, and cessation of parenteral nutrition. The symptoms relapsed when cyclosporin was briefly discontinued and improved following reintroduction of this drug. This experience suggests a role for immune factors in the pathogenesis of the enteropathy in this case and that a trial of cyclosporin is worthy of consideration in similar cases.
A two year follow up of new long-stay patients in an inner city district general hospital.
In 1967 Magnus described 'the new chronics', patients admitted to a psychiatric hospital who then stayed for more than one year. Since that time many studies have examined this patient group but the majority have focussed on psychiatric hospital populations. There is some doubt, however, as to whether the characteristics of new-long stay patients in District General Hospital (DGH) psychiatric in-patient units are comparable. The current paper describes a two year follow-up study of Medium and New-Long Stay patients identified within an inner-city DGH unit in 1986. Elderly patients with affective disorders and patients with organic brain syndromes were particularly highly represented. Length of stay at the time of the original survey, male sex, associated physical disability, and the presence of a secondary diagnosis were particularly associated with poor outcome. The results are discussed in relation to service provision.
Nursing assistant turnover in nursing homes and need satisfaction.
1. Level of Maslow's Hierarchy of Needs is basic physiological needs measured by salary, adequate housing, and food. Attainment of these needs increased the length of stay of nursing assistants in nursing homes. 2. Safety and security (level 2) influenced length of stay of nursing assistants. Those with benefits of retirement, vacation, and holiday pay tended to have less turnover. 3. Praise by the patient and family was most important to nursing assistants. Belonging to a peer group and praise by charge nurse also decreased turnover of nursing assistants (level 3). 4. Level 4, self-esteem measured by input into decisions and being able to criticize, increased length of stay of nursing assistants.
Reduced-size orthotopic liver transplantation in children: an experience with seven cases.
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Mortality in patients on liver transplant waiting lists: an avoidable tragedy.
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Comparison of conventional intermittent positive pressure ventilation with high frequency jet ventilation. Studies following aortocoronary bypass graft surgery.
This study was designed to compare the cardiorespiratory effects of high frequency jet ventilation at 150 breaths/minute with and without added positive and expiratory pressure, with conventional intermittent positive pressure ventilation in 20 patients following aortocoronary bypass graft surgery. On comparison with intermittent positive pressure ventilation, there was a decrease in peak airway pressure during high frequency jet ventilation when positive and expiratory pressure of 0 or 0.5 kPa was applied, but not with 1 kPa, and an increase in mean airway pressure with positive end expiratory pressures of 0.5 and 1 kPa. On changing from intermittent positive pressure to high frequency jet ventilation with no added end expiratory pressure, there was an acute decrease in arterial oxygen tension and increases in cardiac output and total tissue oxygen delivery. On changing from intermittent positive pressure ventilation to high frequency jet ventilation with 1 kPa of positive end expiratory pressure, there was an acute decrease in arterial oxygen tension, cardiac output and oxygen delivery, and increases in pulmonary arterial, right atrial and pulmonary capillary wedge pressures. The addition of positive end expiratory pressure did not prevent the acute decrease in arterial oxygen tension which occurred on transfer to high frequency jet ventilation.
Saltwater drowning and near-drowning accidents involving children. A five-year total population study in south-east Queensland.
A large total population study of childhood saltwater immersion accidents is reported. A total of 49 cases (16 fatalities, 33 survivors) occurred in the five year period from 1971 to 1975 in southeastern Queensland. As a group, more children survive a potentially fatal saltwater immersion (67%) than do those who lose consciousness in freshwater (50%). The serious saltwater accident rate (loss of consciousness or death) in childhood (from 0 to 15 years inclusive, is 3.37/100,000 children per year at risk (fatality rate 1.12). This is low; comparison with freshwater data shows that although the surf presents special hazards to children, it is very much safer than other types of water. Age-specific and site-specific accident and survival rates for saltwater immersions are presented for the first time. Toddlers are disproportionately represented (33% of all children) and their survival rates are lowest. Boating and the use of surfboards, in current practice, are negligible threats to children. The saltwater immersion rate is increasing (although the absolute risk is small) and reasons for this are discussed. Childhood saltwater immersions were unaffected by tidal state. All but one case of immersion occurred during daylight hours, and in younger children immersion occurred often on weekends.
Flurbiprofen at night.
Three double-blind crossover trials were used to study the effects of single doses of flurbiprofen at night on pain at night, duration of morning stiffness and sleep disturbance in patients with active rheumatoid arthritis. Flurbiprofen (150 mg) was shown to be superior to placebo and 150 mg was no more effective than 100 mg. Serum levels of the drug were significantly higher with 150 mg but did not correlate with clinical effects.
A study of oral hygiene in the geriatric patient.
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Prescription for the high cost of drugs in nursing homes.
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Wilson's disease in an Australian aborigine.
Wilson's disease is due to a genetically determined defect inherited as an autosomal recessive trait. Most reported cases have been caucasoid. This report describes a case of Wilson's disease in an Australian Aboriginal girl, only the second such case reported.
Pre-operative nutritional support in children with end-stage liver disease accepted for liver transplantation: an approach to management.
Pre-operative nutritional support was studied in 28 children with end-stage liver disease awaiting orthotopic liver transplantation. Nasogastric supplemental administration of a standard semi-elemental enteral nutritional formula was compared with a similar formula enriched with branched chain amino acids, and with a group receiving oral nutrition only. The duration of treatment in all groups was similar (mean 90 days). Energy intakes in the supplemented groups were 120-150% of recommended daily intakes (RDI), whereas ad libitum intakes in the oral group ranged 58-100% RDI. A significant improvement in mean Z-score for body weight (denoting catch-up) was noted only in those children who received nasogastric supplements enriched with branched-chain amino acids. The standard enterally-fed group maintained their body weight and Z-scores did not change significantly. In contrast, body weight Z-scores in those fed orally declined significantly. Nutritional supportive therapy of malnourished children with end-stage liver disease can minimize or improve nutritional status in children awaiting liver transplantation. The use of nutritional formulae rich in branched-chain amino acids may have nutritional advantages in children with chronic liver disease which require further study and evaluation.
Departmental design.
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