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Biomedical subjects

S Sherman

Publications and source records attributed to S Sherman.

At least 19 recordsLinked to original sources
PubMed1992

Population screening for fragile X.

A screening programme to detect fragile X syndrome has been operating in New South Wales, Australia, since 1984. The aim of this programme is to find previously unidentified individuals with the syndrome so that their extended families can be properly informed of the risks before making decisions about childbearing. 14,225 individuals attending adult and child facilities for the intellectually handicapped have been screened, of whom 8172 have been offered testing for the fragile X syndrome with a 79% uptake of the service. 253 probands were found, and in the extended families 818 females at 25-100% risk of being carriers were interviewed and counselled. Continuing contact was maintained and prenatal diagnosis was offered. The effect of the programme was assessed in a subgroup of 90 individuals, most of whom were appreciative of the service and felt that they had been adequately informed. The influence of knowing the diagnosis and its genetic implications were also assessed, the main consequences being a 26% reduction in births and a 61% uptake of prenatal diagnosis. Improved techniques for diagnosis of fragile X have benefited the families identified and counselled, suggesting that systematic screening for fragile X should be an essential component of community genetic services.

Adolescent↗
PubMed1992

Cor pulmonale. Treatment implications of right versus left ventricular impairment.

Diagnosing cor pulmonale and detecting left ventricular dysfunction in patients with advanced lung disease are difficult challenges. Usually, routine clinical assessment (history, physical examination, chest radiography, and electrocardiography) is inadequate and additional cardiac diagnostic techniques (eg, two-dimensional echocardiography, first-pass radionuclide angiography) are required for definitive documentation. Diagnosis of cor pulmonale and evaluation of cardiac function in patients with advanced lung disease are of more than academic interest. Long-term oxygen therapy, the main treatment option, improves survival rate in these patients. Establishing the coexistence of left ventricular dysfunction is important, because management of congestive heart failure offers little benefit and may even be harmful in patients with cor pulmonale.

Heart Failure↗
PubMed1992

Facilitating research utilization through collaboration.

The rhetorical gap between clinical practice and academia was tested by the development of a special program grant to facilitate use of research by staff nurses. The grant capitalized on an established collaborative relationship between a university school of nursing and a community hospital. The merger of education and practice demonstrated the principles of interinstitutional collaboration in action. Resources of the grant included a doctorally-prepared nurse and a clinical librarian to provide research utilization classes for staff nurses, and an academic credit course to address reality-based practice problems for nurse managers. The model developed for this effort is described and critical behavioral aspects of research utilization for practicing nurses and academic nurses are outlined.

Diffusion of Innovation↗
PubMed1992

Comparison of intraoperative and endoscopic manometry of the sphincter of Oddi.

Despite the potential utility of intraoperative manometry of the sphincter of Oddi, limited data are available validating its use. The current study was undertaken to validate the method of intraoperative sphincter of Oddi manometry by comparing the pressure tracings obtained at operation (transduodenal sphincteroplasty and transampullary septoplasty) and endoscopy (preoperative) in the same group of patients. Seventy-four patients with idiopathic pancreatitis or unexplained disabling pancreaticobiliary pain had sphincter of Oddi manometry performed endoscopically and intraoperatively within six weeks of each other. Thirty-five patients had manometric evaluation of the bile duct segment of the sphincter of Oddi. The mean basal sphincter pressure determined endoscopically and intraoperatively was 41.1 +/- 6.4 millimeters of mercury (mean plus or minus standard error of the mean) and 42.0 +/- 6.8 millimeters of mercury (not significantly different, p > 0.05), respectively. There was no significant difference between the biliary sphincter phasic pressure, phasic frequency and phasic duration, as recorded by the two techniques. Fifty-five patients had manometric evaluation of the pancreatic duct sphincter. The mean basal sphincter pressure determined endoscopically and intraoperatively (after biliary sphincteroplasty) was 111.9 +/- 9.9 millimeters of mercury and 102.7 +/- 8.7 millimeters of mercury, respectively (not significantly different, p > 0.05). There was no significant difference in the pancreatic sphincter phasic duration and phasic frequency determined by the two techniques. However, the pancreatic sphincter phasic pressure was significantly higher when measured endoscopically (p < 0.001). Overall, 70 percent of patients benefited from surgical sphincter ablation therapy. Patients with an elevated basal sphincter pressure determined intraoperatively were more likely to improve than those with a normal basal sphincter pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Pulmonary embolism update. Lessons for the '90s.

Pulmonary embolism continues to be an underdiagnosed, potentially fatal problem. Because clinical diagnosis of pulmonary embolism is notoriously inaccurate, clinical suspicions must always be confirmed with objective studies. Evaluation generally begins with ventilation-perfusion lung scanning. Further evaluation is usually unnecessary if the lung scan is interpreted as normal (diagnosis excluded) or high-probability (diagnosis accepted). However, if the lung scan is indeterminate (referring to all other interpretations), additional diagnostic studies are usually required. Newer trends in the management of pulmonary embolism and deep venous thrombosis include a more aggressive initial regimen of heparin; simultaneous administration of warfarin with heparin, resulting in a shorter duration of heparin therapy; use of the international normalized ratio to monitor warfarin therapy; and use of a less intense warfarin regimen. Adjusted-dose subcutaneous heparin therapy and low-intensity warfarin therapy are newer prophylactic techniques for patients at moderate to high risk for deep venous thrombosis.

Administration, Oral↗
PubMed1991

ERCP- and endoscopic sphincterotomy-induced pancreatitis.

Acute pancreatitis may occur after the performance of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy. During ERCP and endoscopic sphincterotomy, the pancreas is subjected to many types of potential injury--mechanical, chemical, hydrostatic, enzymatic, microbiological, allergic, and thermal. These factors may act independently or in concert to induce postprocedure pancreatitis. The potential role of each etiologic factor in the development of ERCP- and endoscopic sphincterotomy-induced pancreatitis is detailed. The management of this complication is reviewed. Patient factors that increase the risk for pancreatitis and techniques to prevent or limit this complication are described. A variety of agents have been shown to prevent or treat pancreatitis in animal models, but extrapolation to humans has been almost uniformly unsuccessful. Although postprocedure pancreatitis is unlikely to be completely eliminated, careful patient selection and attention to detail may reduce the incidence of this untoward event.

Amylases↗
PubMed1991

Complications of endoscopic sphincterotomy. A prospective series with emphasis on the increased risk associated with sphincter of Oddi dysfunction and nondilated bile ducts.

Mostly retrospective series with limited use of sphincter of Oddi manometry have indicated that early complications are more common when endoscopic sphincterotomy is performed for sphincter of Oddi dysfunction than for common duct stones. The current study was undertaken to prospectively evaluate the frequency and type of complications of endoscopic sphincterotomy performed for sphincter of Oddi dysfunction compared with endoscopic sphincterotomy performed for other conditions. Four hundred twenty-three patients underwent sphincterotomy for sphincter of Oddi dysfunction (166), common duct stone(s) (163), tumor (60), and miscellaneous reasons (34). Patients were observed in the hospital for at least 24 hours after the procedure, and 30-day follow-up data were obtained. The overall complication rate was 6.9%, but complications were more frequent when sphincterotomy was performed for sphincter of Oddi dysfunction than for all other indications (10.8% vs. 4.3%; P = 0.009). Precut sphincterotomy was more frequently required in the sphincter of Oddi dysfunction group (21.1% vs. 11.7%, P = 0.009) but was no more likely to result in a complication (6.2%) than standard sphincterotomy. The risk of a complication was considerable for a small-diameter common bile duct (less than or equal to 5 mm), particularly when sphincterotomy was performed for sphincter of Oddi dysfunction (37.5%). The overall 30-day mortality rate was 1.7%, but the procedure-related mortality rate was believed to be 0.2%. It is concluded that endoscopic sphincterotomy for sphincter of Oddi dysfunction is more hazardous than for other conditions, particularly when a small common bile duct is present.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1991

Frequency of abnormal sphincter of Oddi manometry compared with the clinical suspicion of sphincter of Oddi dysfunction.

Patients with pancreaticobiliary pain or idiopathic pancreatitis have been classified as having definitive (type I), presumptive (type II), or possible (type III) sphincter of Oddi dysfunction (SOD) based on clinical, laboratory, and ERCP data. This study was undertaken to determine the frequency of abnormal sphincter of Oddi manometry (SOM) when patients are classified by this system. Two hundred and thirteen patients with pancreaticobiliary pain were evaluated clinically; SOM, ERCP, and ductal contrast drainage time tests were performed. For biliary types I, II, and III, the frequency of abnormal SOM was 85.7%, 55.1%, and 28.1%, respectively. Similarly, for pancreatic types I, II, and III, an elevated basal sphincter pressure occurred in 92.3%, 58.2%, and 35.1%, respectively. When patients with an abnormal basal sphincter pressure were characterized by the magnitude of the elevation, the manometric profiles were similar for types I, II, and III. These data suggest that elevated sphincter pressure occurs more frequently in type III patients than previously reported, and supports consideration of SOM when evaluating and treating type II and type III patients.

Adolescent↗
PubMed1990

Essential factors in a community college-nursing home partnership.

The community college-nursing home partnership has two major objectives: to develop nursing potential in long-term care settings and to influence the redirection of associate degree nursing education to include active participation in long-term care settings. Successful partnerships are built on a commitment to high quality education for students and high quality service for patients. Other essential factors to a successful partnership include collaborative planning, pragmatic goal setting, clear communication, and mutual respect.

Community Health Nursing↗
PubMed1990

Care for the underinsured: who should pay?

Inner-city medically underinsured adults describe their preferences for health care and willingness to pay for health care services. The responses of 146 patients attest to the burden of administrative and economic responsibility placed on the public health care sector for indigent patient care. The results of this survey address the information required by the nurse managers who must balance patient needs against administrative pressures to generate revenue from patient fees.

Attitude to Health↗
PubMed1989

Combined segregation and linkage analysis for IDDM and HLA-DR under several ascertainment assumptions.

Combined segregation and linkage analysis of the Genetic Analysis Workshop 5 (GAW5) data suggests a complex basis for susceptibility to insulin-dependent diabetes mellitus (IDDM). One susceptibility gene, linked to the HLA-DR region, is additive on the liability scale (d = .49 +/- .15, t = 2.9 +/- .6) with a gene frequency q = .30 +/- .03. A second locus, with a gene frequency of q = .07 +/- .02, which is recessive and unlinked to HLA, is also suggested by the analysis. The ascertainment correction used has little effect on the results, presumably because most of the information comes from the cosegregation of HLA alleles and disease status. The results are consistent with a direct involvement of the HLA-DR region in susceptibility, but are not a proof of it.

Computer Simulation↗
PubMed1989

Letters beget letters.

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Education, Nursing, Associate↗