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Biomedical subjects

S Janes

Publications and source records attributed to S Janes.

At least 19 recordsLinked to original sources
PubMed2005

Elective surgery after acute diverticulitis.

BACKGROUND: Diverticulitis is a common condition. Practice guidelines from many organizations recommend bowel resection after two attacks. The evidence for such a recommendation is reviewed. METHODS: A Medline literature search was performed to locate English language articles on surgery for diverticular disease. Further articles were obtained from the references cited in the literature initially reviewed. RESULTS: Most people with diverticulosis are asymptomatic. Diverticular disease occurs in over 25 per cent of the population, increasing with age. After one episode of diverticulitis one-third of patients have recurrent symptoms; after a second episode a further third have a subsequent episode. Perforation is commonest during the first episode of acute diverticulitis. After recovering from an episode of diverticulitis the risk of an individual requiring an urgent Hartmann's procedure is one in 2000 patient-years of follow-up. Surgery for diverticular disease has a high complication rate and 25 per cent of patients have ongoing symptoms after bowel resection. CONCLUSION: There is no evidence to support the idea that elective surgery should follow two attacks of diverticulitis. Further prospective trials are required.

Acute Disease↗
PubMed2004

Safe introduction of warfarin for thrombotic prophylaxis in atrial fibrillation requiring only a weekly INR.

A new protocol for initiating warfarin therapy was introduced to reduce the workload in the Anticoagulant Clinic. A total of 200 outpatients, with a median age of 74 years, requiring anticoagulation for atrial fibrillation, commenced warfarin 3 mg daily for 1 week. Patients were initially seen weekly, and subsequent warfarin doses were dictated by the International Normalized Ratio (INR) on days 8 and 15; 84% of patients followed the protocol correctly: of these 86% had an INR > or =2 by day 15 and >98% had INR >2 by day 22. By day 22, 58% of patients achieved a stable dose, 85% by day 29 and >95% by day 36. Day 8 INR was predictive of the final maintenance dose required. No patient suffered any thrombotic or haemorrhagic complications in the first month: only three patients had an INR >3 on day 8, and 11 patients had an INR >4 on day 15. Patient age and sex were not sufficiently related to warfarin requirement to provide useful predictive information. This protocol, requiring only weekly INRs, has proved safe and effective for outpatient warfarinization, and has reduced clinic attendances in this population.

Adult↗
PubMed2004

Aleukaemic leukaemia cutis: case report and review of the literature.

'Aleukaemic leukaemia cutis' or acute leukaemia confined to the skin is extremely rare, although skin involvement with underlying leukaemia is well recognized, and is associated with a poor prognosis. We report a case of isolated acute myeloid leukaemia (AML) in the skin. A literature review shows this to be commonly misdiagnosed. Its recognition is important, because early diagnosis should lead to more appropriate chemotherapy, and a better prognosis. These patients probably require therapy directed specifically to the skin, as well as to other extramedullary sites, such as the central nervous system, to prevent early relapse.

Antineoplastic Protocols↗
PubMed2001

Use of a simplified clinical scoring system and D-dimer testing can reduce the requirement for radiology in the exclusion of deep vein thrombosis by over 20%.

A simplified, robust, clinical assessment, used in conjunction with a D-dimer assay, has been developed to identify patients with a low risk of deep vein thrombosis. These patients did not undergo radiological examination. The protocol has been used by junior doctors in a district general hospital with a predominantly elderly population. Four hundred and thirty-one patients with potential deep vein thrombosis of the lower limb were assessed using this method and 98 (22.7%) did not require further investigation. Of these, one was admitted 5 months later with a pulmonary embolus. None of the other patients subsequently required admission for a thromboembolic event or died during a minimum of 3 months follow-up.

Aged↗
PubMed2000

INR: Intervals of measurement can safely extend to 14 weeks.

The number of patients taking warfarin is increasing. Each of these patients requires regular blood tests to ensure that the level of anticoagulation reaches and remains within a defined target range. INR monitoring is expensive and time-consuming and the frequency of the tests has repercussions for NHS resources and patient convenience. Guidelines regarding this are available, but the research on which these are based is extremely limited. Many centres in the UK are using extended intervals between tests that exceed the current guidelines. This study shows that for selected patients the interval between INR tests can safely be extended to 14 weeks with the potential for longer intervals.

Anticoagulants↗
PubMed1998

An innovative approach for affirming cultural diversity among baccalaureate nursing students and faculty.

"Cultural Diversity" has become the buzz word of the nineties. The United States has become the most culturally diverse nation in the world. Since there is no arena where cultural diversity is more critical than health care, it is imperative that nursing students and faculty become comfortable with the issues surrounding the delivery of culturally competent care. The University of Southern Mississippi has developed an innovative program with a dual purpose: (a) to provide an environment of mutual understanding and respect for people of different cultures; and (b) to provide a comfortable environment where minority students can be valued and nurtured.

Cultural Diversity↗
PubMed1995

Transcending the latex barrier: the therapeutics of comfort touch in patients with acquired immunodeficiency syndrome.

Comfort touch has a positive impact on patient outcomes. When using Latex gloves, nurses often overlook the importance of skin-to-skin contact in effective comfort touch. Comfort touch is especially essential in vulnerable populations that are already experiencing several physical and emotional losses. Nurses' attitudes and fears may be a contributing factor to comfort touch not always being provided in caring for patients with acquired immunodeficiency syndrome (AIDS). The article discusses the therapeutics of comfort touch and explores the issues surrounding the absence of comfort touch in nursing interactions in patients with AIDS. Suggestions are made for nursing practice, education, and research.

Attitude of Health Personnel↗