PubMed Health⌕ Search

Biomedical subjects

R Carr

Publications and source records attributed to R Carr.

At least 55 records · Page 3Linked to original sources
PubMed1997

Audit of practice in platelet refractoriness.

OBJECTIVES: A significant number of patients become refractory to platelet transfusion and prompt investigation of the cause will encourage appropriate selection of platelet products. METHODS: We surveyed haematologists to assess perceived practice concerning platelet refractoriness because of the high cost and limited availability of HLA-compatible platelets. Some 56 of 58 consultant haematologists participated. RESULTS: Clinicians differed on their definition of platelet refractoriness, and non-immune factors were not considered as important as immune causes of platelet refractoriness. A working group, including an invited moderator, was established to produce guidelines on recommended practice for the management of platelet refractoriness. Re-audit after implementation of the guidelines showed that more patients receiving HLA-compatible platelets had been tested for HLA antibodies. There was a mean 50.9% reduction in the use of HLA-compatible platelets. CONCLUSIONS: Increased testing for leucocyte and platelet antibodies resulted in reduced demand for and more selective use of HLA-compatible platelets, with no apparent increase in haemorrhagic complications.

Guidelines as Topic↗
PubMed1997

Penetration of clarithromycin into middle ear fluid of children with acute otitis media.

OBJECTIVE: To determine the steady state plasma and middle ear fluid concentrations of clarithromycin and its metabolite, 14(R)-hydroxyclarithromycin in 32 pediatric patients with acute otitis media. METHODS: After the sixth dose of a 7.5-mg/kg every-12-h regimen of clarithromycin suspension, tympanocentesis was performed at 2, 4, 8 or 12 hours postdose. Plasma and middle ear fluid samples were assayed for concentrations of clarithromycin and its 14-hydroxy metabolite. RESULTS: Mean middle ear fluid concentrations ranged from 3.0 to 8.3 micrograms/g during the dosing interval for clarithromycin and from 1.5 to 3.8 micrograms/g for 14(R)-hydroxyclarithromycin. The mean middle ear fluid concentrations were consistently greater than corresponding mean plasma concentrations, which ranged from 0.7 to 3.4 micrograms/ml for clarithromycin and from 0.8 to 1.8 micrograms/ml for 14(R)-hydroxyclarithromycin. The ratios of middle ear fluid to plasma concentration appeared to increase during the dosing interval and were 8.8 and 3.8 for clarithromycin and 14(R)-hydroxyclarithromycin, respectively, 12 h after dosing. CONCLUSIONS: Multiple oral doses of clarithromycin suspension produced sustained middle ear fluid concentrations of clarithromycin and 14(R)-hydroxyclarithromycin which exceed the minimum inhibitory concentrations of most otic pathogens.

Acute Disease↗
PubMed1997

Psychometric evaluation of the Organizational Job Satisfaction Scale.

Findings are reported from a replicated evaluation of the psychometric properties of the Organizational Job Satisfaction Scale. Data lend strong support for the scale which assesses four dimensions of organizational job satisfaction. Principal component factor analysis of data from two independent samples of urban staff registered nurses (RNs) (n = 496; n = 532) confirmed four dimensions of pay, interaction, administration, and status. Cronbach's alpha for subscales ranged from .76 to .88. Pearson correlation coefficients for the interrelationships among subscales and an estimate of theta verified internal consistency. The Organizational Job Satisfaction Scale scores correlated significantly with a criterion measure of job enjoyment. Hypothesis testing of theoretically predictable relationships supported construct validity. Scores on the organizational job satisfaction subscales correlated significantly with automony, stress, and commitment. Item revisions and recommendations for future use of the instrument are discussed.

Adult↗
PubMed1996

Endosonography-guided cholangiopancreatography.

BACKGROUND: Detailed imaging of the common bile duct and main pancreatic duct is possible with endosonography. Utilizing a custom manufactured flexible needle, we have developed a technique of performing endosonography-guided cholangiopancreatography (EGCP). METHODS: Of 205 patients undergoing ERCP, complete ductography was not possible in 11 patients. Employing a linear scanning echoendoscope in conjunction with a 4 cm, 22 to 23 gauge aspiration needle, transduodenal cholangiography (n = 10) or transgastric pancreatography (n = 1) was attempted. RESULTS: Successful ductography was possible in 8 of 11 patients (EGCP success 73% vs ERCP 0%, p < .001, Fisher's exact test). In 5 patients, abnormalities identified on EGCP subsequently led to repeat ERCP with precut sphincterotomy. In all of these cases 100% agreement was found between EGCP and ERCP findings. One postprocedure case of pancreatitis occurred in a patient who underwent EGCP at the same setting as the failed ERCP. No early or late complications occurred in the patient group with EGCP performed at a separate setting. CONCLUSION: EGCP allows an alternative method for obtaining cholangiopancreatography in those patients in whom ERCP is unsuccessful. Further studies are necessary to define the safety and success rate of this new procedure.

Aged↗
PubMed1996

Neonatal nurse practitioners: identity as advanced practice nurses.

OBJECTIVE: To define how neonatal nurse practitioners (NNPs) perceive their identity as advanced practice nurses. DESIGN: Non-experimental descriptive and correlational survey. SETTING: Nationwide random sample drawn from NNPs certified by the National Certification Corporation. PARTICIPANTS: Two hundred fifty-eight neonatal nurse practitioners practicing in neonatal intensive-care units across the United States. MAIN OUTCOME MEASURES: Neonatal Nurse Practitioners indicated on a visual analogue scale at which point their philosophy of practice fell on a continuum from nursing to medicine and specified on a 5-point bipolar Likert scale how various role socialization factors influenced their identity. RESULTS: The NNPs predominantly were certificate-prepared and aligned themselves with a medical philosophy. Those NNPs who were master's-prepared (p < .01), precepted by another NNP (p < .05), espoused a philosophy of nursing (p < .001), belonged to a professional nursing organization (p < .05), and had an NNP role model (p < .001) were more likely to have a strong nursing identity (95% confidence interval). CONCLUSIONS: The issues of role differentiation, socialization, and identity of advanced practice nurses in tertiary care need further exploration. These data support the American Nurses' Association mandate of graduate nursing education for advanced nurse practitioners.

Adult↗
PubMed1995

Trophic effect of collicular proteoglycan on neonatal rat retinal ganglion cells in situ.

Naturally occurring neuronal death is widespread in the central nervous system of mammals. To date, the causes and mechanisms of such death are poorly understood. A major hypothesis is that developing neurons compete for limited amounts of trophic factor(s) released from their target centres as in the case of the peripheral nervous system and nerve growth factor. The present study aims to test this 'trophic hypothesis' in the mammalian central nervous system. In the rat, more than 50% of retinal ganglion cells die in the early post-natal period. Schulz and coworkers [57] purified a potential trophic agent from their major target, the superior colliculus, which was identified as a 480 kDa chondroitin sulfate proteoglycan. This proteoglycan or control solutions were injected into the eyes of rat pups during the post-natal part of the period of naturally occurring ganglion cell death. It was found that the collicular proteoglycan prevented the death of a significant number of the ganglion cells that would normally have been lost over a post-injection period of one or two days. The effect of the proteoglycan was dose- and time-dependent. These results support the notion that trophic interactions are a determining factor in the survival of retinal ganglion cells during the period of naturally occurring cell death. It is also the first time that a proteoglycan has been shown to possess neurotrophic properties in situ.

Animals↗
PubMed1995

Evaluation of the Augustine Guide for difficult tracheal intubation.

Successful tracheal intubation with Augustine Guide (Augustine Medical, Inc., Eden Prairie, MN) in patients with normal airways has recently been described. There are no studies describing Augustine Guide (AG) use in patients with difficult airways. Accordingly, we studied AG intubation in a population of patients with expected difficult airways due to cervical spine pathology, limited mouth opening, obesity, facial trauma or deformity due to previous operation or radiation and in patients with unexpectedly difficult airways. A total of 44 patients were studied. The AG was used as a primary intubating tool in patients with known difficult airways (n = 36) and as a secondary intubating tool in patients with unexpected inability to intubate using conventional direct laryngoscopy (n = 8). Airway difficulty was predicted by history and physical examination. Intubations were performed under general anaesthesia in 40 of the 44 patients studied. In four patients with predictably difficult airways, topical anaesthesia and sedation were used. Backup methods to achieve intubation were available. Thirty-two of the 36 with known or suspected difficult airways were classified as Mallampati Class III or IV. In the remaining eight patients the preoperative examination suggested an easy airway; however, after induction of general anaesthesia, their laryngeal inlet could not be seen using direct laryngoscopy. Using the AG, all were intubated successfully (36/44 at the first attempt, in 8/44 repositioning of the AG to allow successful laryngeal entry of the stylet was necessary). There were no failures or complications secondary to AG use. This study shows that the AG is a useful device for oral tracheal intubation in patients with known or unexpectedly difficult airways.

Adult↗
PubMed1995

Staging of Burkitt's lymphoma and response to treatment monitored by PET scanning.

Positron emission tomography (PET) is an imaging technique using biological tracers (18-fluorine fluorodeoxyglucose (FDG)), whose uptake into tumour cells is increased. Previous studies carried out in patients with lymphoma have shown that PET is an accurate method of staging disease and that a high pre-treatment FDG uptake that is abolished by the end of chemotherapy is associated with a good clinical response. This case report demonstrates that clinical PET scanning can be especially useful in staging patients with lymphoma in whom there is extensive extranodal and marrow involvement, and that PET can follow changes in tumour viability over a very short time span.

Adult↗
PubMed1995

Creating a successful environment for neonatal nurse practitioners.

Factors that contribute to the neonatal nurse practitioner (NNP) practice environment have emerged from research grounded in the results of a nonexperimental, descriptive, and correlational study that described the role and nursing identity of 258 NNPs. These factors may be used as prescriptions for developing successful NNP environments or to strengthen a current practice. Nursing management has a responsibility to identify factors that enhance nursing identity of NNPs and to plan strategies to operationalize those factors to provide an optimal environment in which NNPs can practice to their fullest potential. Implications are raised for nursing administration and education to address the issues of role differentiation, socialization, and identity of advanced practice nurses in tertiary care.

Humans↗
PubMed1995

Myelodysplastic syndrome presenting as cutaneous vasculitis.

A patient presenting with cutaneous vasculitis was noted to be pancytopenic. Subsequent investigation showed a myelodysplastic syndrome (MDS)--refractory anaemia with excess of blasts. Within 3 months her MDS progressed to acute myeloid leukaemia.

Acute Disease↗
PubMed1995

Neutrophils from preterm neonates and adults show similar cell surface receptor expression: analysis using a whole blood assay.

Previous work has shown that Fc gamma RIII expression in isolated neonate neutrophils is defective. We have re-examined this phenomenon in view of the facts that (1) the receptor is present on mobilisable subcellular stores and (2) commonly used isolation procedures can affect receptor expression in suspensions of isolated neutrophils. Receptor expression was measured by fluorescence-activated cell sorter analysis of neutrophils in unfractionated whole blood. Examination of receptor expression in preterm, term and adult neutrophils indicated small but significantly decreased expression of CR1 and CR3 in preterm neutrophils compared with term neutrophils (p < 0.01). A small decrease in expression was found for Fc gamma RI and Fc gamma RIII (p < 0.05). No significant difference in expression of Fc gamma RII was observed in all groups analysed. These data suggest that isolated preterm neonate neutrophils have greatly decreased expression of Fc gamma RIII because of impaired composition or mobilisation of the subcellular stores of this receptor and/or increased lability of the surface receptor which leads to its shedding during purification.

Adult↗