Biomedical subjects

S Bergquist

Publications and source records attributed to S Bergquist.

12 recordsLinked to original sources

PubMed2001

Braden scale: validity in community-based older adults receiving home health care.

The purpose of this study was to examine the validity of the Braden Scale and optimal frequency of risk reassessment in older adults receiving home health care. Data were collected from the records of 1,711 nonhospice patients aged 60 years or older who did not have pressure ulcers at the beginning of home health care. Patient records were followed forward chronologically to one of two outcomes: pressure ulcer development or pressure ulcer absence (pressure ulcer free when home health services were no longer required, institutionalization, death, or end of study period). After commencement of home health care, 108 subjects developed a stage I-IV pressure ulcer (incidence = 6.3%). A Braden Scale cutoff score of 19 provided the best measure of sensitivity (61%) and specificity (68%). Findings suggest initial assessment of pressure ulcer risk for older adults should begin on entry into home health care, and they indicate the need for weekly reassessments for the first 4 weeks with every other week reassessments thereafter until day 62, dependent on patient condition and the frequency of home visits. Reassessment with each subsequent 62-day recertification period may be sufficient for patients remaining on the active caseload.

Aged↗

PubMed2001

Subscales, subscores, or summative score: evaluating the contribution of Braden Scale items for predicting pressure ulcer risk in older adults receiving home health care.

PURPOSE: The purpose of this study was to determine whether certain Braden subscales or subscores were more important than others or the summative score in predicting stage I to IV pressure ulcers among older adults receiving home health care. DESIGN: A retrospective cohort study (secondary analysis) was used. SETTING AND SUBJECTS: The cohort sample included 1684 nonhospice patients who were not receiving intravenous therapy and who were admitted to the Intermittent Skilled Nursing Division of a large midwestern home health care agency between January 1995 and March 1996. The patients were > or =60 years and free of pressure ulcers. METHODS: Demographic data and data on the Braden Scale were extracted from admission information. Patient records were followed forward chronologically to 1 of 2 outcomes: development or absence of pressure ulcers (ie, free of pressure ulcers upon discharge, institutionalization, death, or the end of the study period). RESULTS: Following admission, a stage I to IV pressure ulcer developed in 107 subjects (incidence = 6.3%). Cox regression analysis revealed that activity and moisture subscale scores predicted pressure ulcer development. Regression modeling of individual Braden Scale subscores (response categories) revealed that problems with friction/shear, being very limited in mobility, and being constantly moist, very moist, or occasionally moist predicted pressure ulcer development. When the overall level of risk was added to each of these models, the Braden Scale summative score was most strongly related to pressure ulcer development. No simplified scale improved risk prediction. CONCLUSIONS: When the Braden Scale was used, the summative score rather than any subscale or subscore best predicted pressure ulcer risk among the older adults receiving home health care.

Aged↗

PubMed2000

Bone and joint infections in the elderly: practical treatment guidelines.

Two types of haematogenous osteomyelitis that are seen in the elderly are vertebral and long bone osteomyelitis. Osteomyelitis secondary to contiguous foci of infection can occur in older adults without vascular insufficiency (secondary to pressure ulcers) or with vascular insufficiency due to diabetes mellitus or peripheral vascular disease from atherosclerosis. Most cases of osteomyelitis can be reasonably treated with adequate drainage, thorough debridement, obliteration of dead space, wound protection, and antimicrobial therapy. Patients are initially given a broad spectrum antimicrobial that is changed to specific antimicrobial therapy based on meticulous bone cultures taken at debridement surgery or from deep bone biopsies. Surgical management is often required in the treatment of osteomyelitis and includes adequate drainage, extensive debridement of all necrotic tissue, obliteration of dead spaces, stabilisation, adequate soft tissue coverage, and restoration of an effective blood supply. Bone repair and bone mineral density may be significantly retarded and may be corrected by eliminating risk factors, supplementing the diet with calcium, bisphosphonates, and/or vitamin D, and treating with testosterone and/or estrogen when deficient. Sodium fluoride treatment and anabolic steroids may be used as alternatives. Septic arthritis is a medical emergency, and prompt recognition and rapid and aggressive treatment are critical to ensuring a good prognosis. The treatment of septic arthritis includes appropriate antimicrobial therapy and joint drainage. Adverse effects of prescribed antibacterials occur more often in the elderly patient than in young adults. The physician can help to minimise the incidence of adverse effects and improve outcomes by being aware of the principles of clinical pharmacology, the characteristics of specific drugs, and the special physical, psychological and social needs of older patients.

Aged↗

PubMed1999

Pressure ulcers in community-based older adults receiving home health care. Prevalence, incidence, and associated risk factors.

OBJECTIVES: To determine the prevalence and incidence of pressure ulcers in community-based adults receiving home health care and to identify risk factors for incident Stage II to IV pressure ulcers. DESIGN: Retrospective cohort study. SETTING: A large midwestern urban home health care agency. PATIENTS: The study cohort was 1711 nonhospice, nonintravenous therapy subjects admitted between January 1995 and March 1996 who were > or = age 60 and pressure ulcer-free on admission. MEASUREMENTS: Data on risk factors were extracted from admission information. Patient records were followed forward chronologically to the outcomes: pressure ulcer development or no pressure ulcer. MAIN RESULTS: The incidence of Stage II to IV pressure ulcers was 3.2%. Cox regression analyses revealed that limitation in activity to a wheelchair, needing assistance with the activities of daily living--dressing, bowel and/or bladder incontinence, a Braden Scale mobility subscore of very limited, anemia, adult child as primary caregiver, male gender, a recent fracture, oxygen use, and skin drainage predicted pressure ulcer development (P < or = 0.05) in this exploratory model. CONCLUSIONS: Patients > or = age 60 who are admitted to a home health care agency with 1 or more of these risk factors require close monitoring for pressure ulcer development and should be taught preventive interventions on admission.

Activities of Daily Living↗

PubMed1995

Adoption of a research-based practice for treatment of pressure ulcers.

Evaluation of a skin care protocol for the treatment of pressure ulcers in this institution showed that practitioners did adopt research-based practice. This change in practice was associated with a corresponding decrease in costs for treatment. More pressure ulcers received treatment after implementation of the protocol. Furthermore, the majority of pressure ulcers were being treated with wound care modalities identified by research as supportive of healing. Use of antiseptic agents harmful to the healing process declined as did use of topical agents with little research base to support their efficacy. The shift to practice patterns that were more consistent with research findings was associated with a corresponding decrease in costs for pressure ulcer treatment. Factors in this situation that lead to the positive outcome of knowledge utilization were an organizational model that promoted accountability of individual practitioners, staff participation in decision making, agency regard for research, and consultation with a nurse expert. Informal individual utilization of knowledge related to the treatment of pressure ulcers reinforced use of the research-based practice and expedited formal implementation of a policy/procedure related to their treatment. The process of knowledge utilization that occurred in this institution provides a prototype of how research can be translated into practice. Although limited to one specific clinical problem, the results of this process can be applied to any clinical condition where there are sufficient research findings to support development of recommendations for practice.

Aged↗

PubMed1994

Parish nursing--a conceptual framework.

Parish nursing is a current nursing care delivery model that practices holistic health care. Parish nurses provide care to a faith community, emphasizing the relationship between faith and health. Specific nursing activities address physical, emotional, and spiritual health and well-being, closely attending to the inseparability of these dimensions. Parish nurses may assume one or more roles associated with this practice to accomplish parish nursing activities and achieve the holistic health and well-being of individuals, families, and groups within the faith community. The five broad categories of client, health, nurse, environment, and nursing process provide a framework for organizing the concept of parish nursing for future nursing theory, research, and practice.

Christianity↗

PubMed1993

Demonstration of immunoglobulin G with affinity for dopamine in cerebrospinal fluid from psychotic patients.

Using an enzyme-linked immunosorbent assay, significantly raised concentrations of immunoglobulin G with affinity for the neurotransmitter dopamine were demonstrated in cerebrospinal fluid from psychotic patients. We have varied the antigen presentation in order to find a conjugate with low unspecific binding. The conjugation of dopamine to carbodiimide-activated poly-L-glutamic acid and that to activated succinimide ester of biotin are described. The use of glutaraldehyde conjugation is not recommended because of the risk of formation of tetrahydroisoquinolines. A strong correlation (r = 0.94, P < 0.001) between the results obtained with dopamine conjugated to poly-L-glutamic acid and dopamine conjugated to biotin was observed. Forty-two human cerebrospinal fluid samples from 20 psychotic patients, (12 with a bipolar disorder and 8 with schizophrenia) and 22 control patients, with various neurological diseases but no apparent psychiatric diseases were investigated. A significantly higher incidence (P < 0.001) of antibodies with affinity for dopamine were found in the group of psychotic patients compared with the neurological control group.

Adolescent↗

PubMed1992

Radio-immunoassay of atrial natriuretic peptide (ANP) and characterization of ANP immunoreactivity in human plasma and atrial tissue.

A sensitive radio-immunoassay (RIA) was developed to determine the occurrence of atrial natriuretic peptide (ANP) in plasma and atrial extracts from patients undergoing open heart surgery. The immunoreactive ANP (irANP) was characterized by high-pressure liquid chromatography coupled with RIA. The plasma irANP response to releasing stimuli during the operation was determined in simultaneously sampled venous and arterial blood, in order to evaluate any differences. The antiserum recognized the intact ring-structure of alpha-humanANP (alpha-hANP) and its propeptide gamma-hANP, as well as beta-hANP, an anti-parallel dimer of alpha-hANP. Less bioactive N-or C-terminal fragments of alpha-hANP, or an N-terminal fragment of the propeptide, gamma-hANP 1-67, did not cross-react with the antiserum. Sep Pak C18-extraction of plasma resulted in an 80% recovery of synthetic alpha-hANP. The assay had a sensitivity of 1.9 pmol l-1, well below the venous plasma concentrations of irANP found in healthy volunteers (7.4 +/- 1.3 pmol l-1, mean +/- SEM, n = 19), and the local standard was identical to an international standard of alpha-hANP. In atrial extracts three major peaks of irANP were identified as alpha-, beta- and gamma-hANP, with gamma-hANP as the most abundant form. In plasma alpha-hANP dominated, but in two cases high plasma levels of beta-hANP were seen, reflecting the high atrial content in these patients. In peripheral arterial blood, irANP was on an average 56% +/- 20% (p less than 0.01, n = 18) higher than in venous blood; this was associated with more distinct arterial irANP responses to releasing stimuli during the operation.

Animals↗

PubMed1989

Reduction of immunoreactive ACTH in plasma following intravenous injection of delta sleep-inducing peptide in man.

Eleven healthy male volunteers, ages 25-39 years, received a single dose of synthetic delta sleep-inducing peptide (DSIP) (25 nmol/kg BW) or saline intravenously in a randomized cross-over, double-blind study. The concentrations of neuropeptides related to the hypothalamic pituitary-adrenal (HPA) axis and cortisol were examined in serial plasma samples. In addition, cortisol and monoamine metabolites were determined in urine. A significant reduction of ACTH-like immunoreactivity (ACTH-LI) in plasma was detected for at least 3 hr after the DSIP injection, compared to the control subjects, in whom a slightly elevated concentration of ACTH-LI occurred. Plasma cortisol levels were unaffected and followed the normal diurnal decline. No differences in urinary cortisol or monoamine metabolite concentrations occurred between the two groups. The results indicate an inhibitory action of DSIP on ACTH secretion in man, as previously suggested by animal experiments.

Adrenocorticotropic Hormone↗

PubMed1984

Multidimensional column liquid chromatography with electrochemical detection for the analysis of terbutaline in human plasma.

Because of low drug concentrations and complex nature of the sample, analytical methods with sensitive and selective detection are necessary for pharmacokinetic studies of terbutaline. Up to now, for non-radiolabelled drugs, usually only methods based on gas chromatography plus mass spectrometry have met these requirements. As an alternative, we have developed an automated method based on liquid chromatography. The necessary sensitivity and selectivity were obtained by using electrochemical detection and a microprocessor-controlled column switching system. The accuracy of the method was compared with a method based on gas chromatography plus mass spectrometry. The overall precision expressed as per cent of the mean was +/- 3.5% and +/- 2.2% at 5 and 50 pmol/mL, respectively. The total absolute recovery for terbutaline and internal standard at these concentration levels were in the range 85-106%.

Autoanalysis↗

PubMed1976

Pharmacist as a provider of oncology ambulatory care services.

The services provided by a pharmacist to ambulatory oncology patients is described. The pharmacist takes drug histories, monitors drug therapy, gives patient discharge consultations and acts in cooperation with local physicians and the medical staff in providing chemotherapy to cancer patients for home administration. The pharmacist also provides inservice education and acts as a consultant to the medical, nursing and pharmacy staffs.

Ambulatory Care↗

PubMedDate not supplied

The cost of treating pressure ulcers following implementation of a research-based skin care protocol in a long-term care facility.

Although concern for the costs associated with pressure ulcer treatments persists, studies that precisely quantify costs are limited. A retrospective research design was used to describe the costs incurred by an 830-bed, long-term care facility to treat 81 pressure ulcers over a one-year period following implementation of a research-based, skin care protocol. The total cost for the study period was $30,079 with 73% of these expenditures attributable to nursing care. Mean cost of treatment was $3.74/pressure ulcer/day, which was a reduction from the $5.35/pressure ulcer/day cost prior to implementation of the skin care protocol. These findings suggest that implementing a research-based, skin care protocol can promote a reduction in treatment costs.

Adult↗