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Biomedical subjects

W Fisher

Publications and source records attributed to W Fisher.

At least 19 recordsLinked to original sources
PubMed2001

Self-injurious behavior: gene-brain-behavior relationships.

This paper summarizes a conference held at the National Institute of Child Health and Human Development on December 6-7, 1999, on self-injurious behavior [SIB] in developmental disabilities. Twenty-six of the top researchers in the U.S. from this field representing 13 different disciplines discussed environmental mechanisms, epidemiology, behavioral and pharmacological intervention strategies, neurochemical substrates, genetic syndromes in which SIB is a prominent behavioral phenotype, neurobiological and neurodevelopmental factors affecting SIB in humans as well as a variety of animal models of SIB. Findings over the last decade, especially new discoveries since 1995, were emphasized. SIB is a rapidly growing area of scientific interest to both basic and applied researchers. In many respects it is a model for the study of gene-brain-behavior relationships in developmental disabilities.

Animals↗
PubMed2001

Nonviolent psychiatric inpatients and subsequent assaults on community patients and staff.

Health care staff on psychiatric inpatient units are at high risk for work-related assaults by patients. Recent studies have begun to document similar patient assaults toward staff in community-based residences. Earlier community studies did not control for the level of patient assault prior to community discharge, and it remains unknown whether the community residence assaults were a function of community placement or a reflection of ongoing control issues by the recently discharged patients. This preliminary inquiry retrospectively tracked the nature and frequency of assaults by patients newly discharged to community residences from a state hospital setting where there had been no assaults by these patients for a two-and-one half-year period. While base rates remain to be determined, the findings in this study suggest the assaultive patients to be younger males with diagnoses of schizophrenia and histories of violence toward others, substance abuse, and violence toward self. Nine patients committed the majority of the assaults. There was a significant decline in the frequency of assaults nine months post-discharge. The implications are discussed.

Adult↗
PubMed2001

Cervical sympathetic schwannoma: case report.

OBJECTIVE AND IMPORTANCE: Approximately 20 to 27% of neck masses in the parapharyngeal space may be benign nerve sheath tumors. Cervical sympathetic chain schwannomas or vagal nerve schwannomas are most common. We report a patient with a cervical sympathetic chain schwannoma. CLINICAL PRESENTATION: The patient was a 47-year-old Caucasian man with a 7-month history of a painless, enlarging right neck mass. No hoarseness or Horner's syndrome was found preoperatively. Formal head and neck examination in the otolaryngology department revealed no vocal cord dysfunction. INTERVENTION: By use of a standard right carotid incision, a tumor was identified growing from the cervical sympathetic chain posterior to the carotid bifurcation. A gross total resection was performed and a section of the cervical sympathetic chain was sacrificed. CONCLUSION: Cervical sympathetic chain schwannomas are unusual tumors that require microneurosurgical resection for cure. We discuss the differential diagnosis, evaluation, surgical management, and pathological characteristics of such tumors and review the literature.

Diagnosis, Differential↗
PubMed2001

"Nurse, my head hurts": a review of childhood headaches.

Headache, a frequent occurrence during childhood, can have a number of etiologies. Most headaches are benign, but all require appropriate assessment. Common types include sinusitis, migraine, and muscle contraction (tension). Headache assessment includes both history and physical examination. The headache history consists of the history of present illness, past history, family history, and environmental and social history. Physical examination begins with general observation and vital sign measurement and proceeds to specific inspection of the head, neck, and facial structures. The nursing interventions carried out are dependent on the interpretation of assessment findings. Pharmacologic interventions, commonly acetaminophen or ibuprofen, may be appropriate if pain management protocols exist. Nonpharmacologic strategies for headache relief include reassurance, rest, ingestion of simple and complex carbohydrate foods, relaxation exercises, or home care. Children with migraine headaches benefit from specific interventions, and children exhibiting headache warning signs should have emergency measures instituted.

Acetaminophen↗
PubMed2001

A preliminary analysis of psychophysiological variables and nursing performance in situations of increasing criticality.

OBJECTIVE: To examine the relationship between psychological, physiological, and performance variables in intensive care unit (ICU) nurses in situations of increasing criticality. SUBJECTS AND METHODS: Psychophysiological variables and endotracheal suctioning performance were examined in a classroom, a skills laboratory, and an ICU. Situation-specific anxiety (state anxiety) and the predisposition to view situations as threatening (trait anxiety), cognitive appraisal, and heart rate were measured and compared with self-appraisal and a nurse instructor's ratings of suctioning performance. Baseline data were obtained during class on 45 novice ICU nurses. RESULTS: Twenty-six nurses provided complete data, which included being videotaped and monitored in the classroom, in the skills laboratory performing endotracheal suctioning, and in the ICU during suctioning. High state anxiety significantly predicted poor ICU suctioning performance (P<.04). Nurses high in state and trait anxiety, worry, and heart rate performed poorly compared with less anxious nurses. Nurses in this study who performed best had a mean heart rate of 94 beats/min. CONCLUSION: Those nurses who are high state anxious, high trait anxious, and worried and who had a faster heart rate performed less well than their more relaxed peers. Nurses with high state anxiety may be at risk for attrition, burnout, medical errors, and poor performance in other ICU nursing tasks.

Anxiety↗
PubMed2000

Assaults on staff by psychiatric patients in community residences.

The study examined assaultive behavior directed toward staff of community-based residential facilities by patients who had been discharged to these facilities from Massachusetts state psychiatric hospitals in the early 1990s. Observed rates of assault declined by 61 percent over a six-and-a-half-year period. Early in the study period, male patients were more likely than female patients to be assaultive, but men and women had similar rates of assaultiveness later in the study period, after they had been in residential placements for several years. The most common diagnosis among assaultive patients was schizophrenia.

Adult↗
PubMed2000

Characteristics of substance-abusing persons with schizophrenia: the paradox of the dually diagnosed.

Previous studies have noted the paradox of the dually-diagnosed (serious mental illness and substance abuse) in which the dually-diagnosed are judged to be both behaviorally more disorganized and simultaneously more socially competent. This study sought to further assess this paradox with a large sample size and a comprehensive assessment approach. In this study, the dually-diagnosed (N = 233) differed significantly from the non-dually-diagnosed (N = 262) in the symptom paradox. The dually-diagnosed were judged both more behaviorally disorganized and socially intact. The comprehensive assessment approach yielded empirical data in support of three possible hypotheses to explain the paradox. The implications of the findings and the three possible hypotheses are discussed.

Activities of Daily Living↗
PubMed2000

Evidence of a structural effect for alcohol outlet density: a multilevel analysis.

BACKGROUND: Ecological studies reveal that alcohol-related outcomes tend to occur in high alcohol outlet density neighborhoods. The ecological design of these studies limits the interpretation of the findings in terms of the level of the effect. The effect of alcohol outlet density could be related to greater individual access to alcohol, an individual level effect, or to the grouping of drinkers by neighborhood, a structural effect at the neighborhood level. METHODS: To differentiate between individual and neighborhood level possibilities, we conducted a multilevel study. Individual distance to the closest alcohol outlet was the individual level measure of the effect of alcohol outlet density, whereas the mean distance to the closest alcohol outlet for all individuals within a census tract was the neighborhood level measure for the effect of alcohol outlet density. We analyzed telephone surveys of 2604 telephone households within 24 census tracts stratified by poverty status and alcohol outlet density. Individual distance to alcohol outlets, age, sex, race/ethnicity, and level of education were entered as individual level covariates, and their corresponding aggregated means were entered as census tract level covariates (i.e., mean distance to outlets, mean age, percentage male, percentage Black, mean education). RESULTS: Analysis of variance revealed that 16.2% of the variance in drinking norms and 11.5% of the variance in alcohol consumption were accounted for at the census tract level. In multivariate hierarchical analysis, individual distance to the closest alcohol outlet was unrelated with drinking norms and alcohol consumption, whereas mean distance to the closest alcohol outlet demonstrated a negative relation with drinking norms (betae = -5.50+/-2.37) and with alcohol consumption (betae = -0.477+/-0.195); that is, the higher the mean distance to the closest alcohol outlet, the lower the mean drinking norms score and mean level of alcohol consumption. CONCLUSIONS: The findings suggest that the effect of alcohol outlet density on alcohol-related outcomes functions through an effect at the neighborhood level rather than at the individual level. Problem drinkers tend to be grouped in neighborhoods, an effect predicted by alcohol outlet density.

Adult↗
PubMed1999

The effects of athletic training and muscle contractile character on the pressor response to isometric exercise of the human triceps surae.

In this study, the influence of athletic training status and the contractile character of the active muscle on the magnitude of the pressor response (PR) to voluntary and electrically evoked isometric plantar flexion was investigated. Subjects were 10 sprint-trained athletes (sprint) (100-m, 200-m and 400-m) [mean (SD) age, 21 (2) years], 14 endurance trained athletes (distance) [22 (2) years] and 8 untrained men (control) [23 (3) years]. Twitch time to peak tension (TPT) in the sprint group [108 (7) ms] was significantly less (P<0.001) than that of the distance group [124 (10) ms]. During voluntary contraction, the mean change in systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (fc) was not significantly different between groups. During electrically evoked contractions, mean changes in SBP, DBP and fc were not significantly different between the sprint, distance and control groups. However, division of the sprint group into 400-m (sprint I) and 100/200-m athletes (sprint II) showed that an increase in DBP of 1.6 kPa (12 mm Hg) in sprint I was significantly less (P<0.05) than the 2.5 kPa (19 mm Hg) increase observed for both the distance and control groups. Prediction of the DBP response from our previously published relationship between TPT and DBP showed close agreement in all subject groups except sprint I; in these subjects the observed DBP response was only 55% of that predicted. Attenuation of the PR in the involuntary experiment suggests that some aspect of sprint training, but not endurance training, modifies the muscle afferent input to the PR in man.

Adult↗
PubMed1999

An epidemiological evaluation of the use of microbiological tools for identifying gonorrhoea infection networks.

We aimed to assess the utility of various techniques for identifying gonorrhoea infection networks. All residents of a non-metropolitan North Carolina county visiting a sexually transmitted disease (STD) clinic during a 17-month period were screened for gonorrhoea. Infection networks were estimated by serovar type combined with antibiotic resistance, arbitrarily primed polymerase chain reaction (AP-PCR), or temporal clustering. The residential addresses of infected patients were geocoded and mapped. Among 2 serovar types, the presence of distinguishing characteristics of a network, based on questionnaire data, was assessed with prevalence ratios and 95% confidence intervals (CIs) relative to those not in the network. Twenty-five serovar types were identified among 759 gonorrhoea infections. In one serovar, the networks further delineated by temporal clusters correlated with particular AP-PCR types. In most instances, however, different typing techniques painted different network pictures. No refined serovar network stood out as having a particular set of characteristics that could be used to shape intervention. Teasing out an individual infection network with unique characteristics will require the development and use of other microbiological tools.

Adult↗
PubMed1998

The natural history of untreated lower urinary tract symptoms in middle-aged and elderly men over a period of five years.

OBJECTIVES: To describe changes in untreated lower urinary tract symptoms (LUTS), levels of bothersomeness and interference in selected living activities arising from LUTS in a cohort of men followed up for a period of 5 years. METHODS: 1,994 men aged 40-79 years registered in four health centres in Scotland completed a urinary symptom questionnaire in the community. 1,177 (71% of original eligible participants) were followed up at 5 years. RESULTS: The mean level of LUTS and the level of bothersomeness they caused increased universally between baseline and 5 years. The largest increases in mean symptom levels occurred for straining, hesitancy, incomplete emptying, weak stream and nocturia, and for mean levels of bothersomeness, i.e. dribbling, incomplete emptying, weak stream, frequency, nocturia and intermittency. The increase in mean interference level in selected living activities arising from LUTS was less marked. The progression of LUTS over time in individual men was very variable; however, the overall trend was one of continuing deterioration. CONCLUSION: If left untreated, overall levels of middle-aged and elderly mens' LUTS, bothersomeness and interference in selected activities caused by these symptoms will increase over time.

Adult↗
PubMed1998

A medial linkage orthosis to assist ambulation after spinal cord injury.

A "proof of concept" prototype of a new device to link bilateral knee-ankle-foot orthoses, the Mooring Medial Linkage Orthosis (Moorong MLO), is presented. The device consists of an arcuate sliding link centred on the hip joints with rolling element bearings to minimise friction. A single repeated-measures case study is reported in which a woman with an incomplete C6 tetraplegia ambulated over different surfaces and gradients using both the Moorong MLO and the Walkabout orthosis. Results demonstrated a slight increase in gait velocity in the Moorong MLO (between 0.36-1.02 m/min faster) and a consistently lower oxygen cost across all conditions (between 18-61% reduction) compared to the Walkabout orthosis. The reduction was most noticeable on sloping surfaces. These preliminary results suggest an improved efficiency of ambulation in this new device.

Adult↗
PubMed1997

A relative-value-based system for calculating faculty productivity in teaching, research, administration, and patient care.

PURPOSE: To design and test a simple, easily modifiable system for calculating faculty productivity in teaching, research, administration, and patient care in which all areas of endeavor would be recognized and high productivity in one area would produce results similar to high productivity in another at the Louisiana State University School of Medicine in New Orleans. METHOD: A relative-value and time-based system was designed in 1996 so that similar efforts in the four areas would produce similar scores, and a profile reflecting the authors' estimates of high productivity ("super faculty") was developed for each area. The activity profiles of 17 faculty members were used to test the system. RESULTS: "Super-faculty" scores in all areas were similar. The faculty members' mean scores were higher for teaching and research than for administration and patient care, and all four mean scores were substantially lower than the respective totals for the "super faculty". In each category the scores of those faculty members who scored above the mean in that category were used to calculate new mean scores. The mean scores for these faculty members were similar to those for the "super faculty" in teaching and research but were substantially lower for administration and patient care. When the mean total score of the eight faculty members predicted to have total scores below the group mean was compared with the mean total score of the nine faculty members predicted to have total scores above the group mean, the difference was significant (p < .0001). For the former, every score in each category was below the mean, with the exception of one faculty member's score in one category. Of the latter, eight had higher scores in teaching and four had higher scores in teaching and research combined. CONCLUSION: This system provides a quantitative method for the equal recognition of faculty productivity in a number of areas, and it may be useful as a starting point for other academic units exploring similar issues.

Delivery of Health Care↗
PubMed1997

The cost and outcomes of community-based care for the seriously mentally ill.

OBJECTIVE: To examine the cost-effectiveness of community-based mental health care. DATA SOURCES/STUDY SETTING: Administrative data from Medicaid and the Massachusetts Department of Mental Health; primary data from 144 psychiatrically disabled adult Medicaid beneficiaries who lived in Boston, central Massachusetts, and western Massachusetts. STUDY DESIGN: A cross-sectional observational study compared the costs and outcomes of treatment in three different types of public mental health service systems. DATA COLLECTION/EXTRACTION METHODS: Beneficiaries, randomly sampled from outpatient mental health programs, were interviewed about their mental health status. All their acute treatment and long-term continuing care for the preceding year were abstracted from Medicaid and Department of Mental Health files. Costs were extracted from Medicaid paid claims and from Department of Mental Health contracts and other financial documents. PRINCIPAL FINDINGS: Clients in the region allocating a greater proportion of its Department of Mental Health budget to community support services used far fewer hospital days, resulting in lower per person treatment expenditures. Outcomes, however, were not significantly different from outcomes of clients in the other regions. For all regions, substance abuse comorbidity increased hospitalization and total treatment costs. An individual-level cost-effectiveness analysis identified western Massachusetts (community-based care) as significantly more cost effective than the other two regions. CONCLUSIONS: Systems with stronger community-based orientation are more cost effective.

Adult↗
PubMed1996

Managing the care of schizophrenia. Lessons from a 4-year Massachusetts Medicaid study.

BACKGROUND: In 1992, Massachusetts launched a state-wide managed care plan for all Medicaid beneficiaries. METHODS: This retrospective, multi-year, cross-sectional study used administrative data from the Massachusetts Division of Medical Assistance and Department of Mental Health, consisting of claims for 16,400 disabled adult patients insured by Medicaid in Massachusetts between July 1, 1990, and June 30, 1994. The main outcome measures include annual rates of hospitalization, emergency department utilization, and follow-up care 30 days after discharge; length of inpatient stay; and per-person inpatient and outpatient expenditures. RESULTS: Between 1991 and 1994, the likelihood of an inpatient admission decreased from 29% to 24% and was accompanied by a slight reduction in length of stay (median number of bed-days per admission dropped by 3.3 days). There was a slight decrease in the number of patients who sought care in general hospital emergency department utilization. However, there was a small increase in the fraction of patients readmitted within 30 days of discharge. Medicaid and Department of Mental Health expenditures for mental health per treated beneficiary decreased slightly, from $11,060 to $10,640, during the 4-year study period. CONCLUSION: Although per-person expenditures dropped and most patient patterns of care remained the same, longer-term study is recommended to asses whether the trends can be maintained.

Adolescent↗
PubMed1996

Quantitative analysis of hyaluronan in human synovial fluid using capillary electrophoresis.

The glycosaminoglycan, hyaluronan, can be detected in human synovial fluid by capillary electrophoresis (CE). Variations in peak shape make this technique unsuitable for quantitative analysis of hyaluronan in raw synovial fluid. Quantitative analysis was achieved by hydrolysis of the polymeric hyaluronan to the tetrasaccharide by the action of testicular hyaluronidase and separation of the product using CE. A UV detector operating at 200 nm was used. The X-ray contrast material, omnipaque, a propriety aqueous solution of iohexol was used as internal standard. A second peak in the electropherogram of synovial fluid was quantified. The variation in concentrations of these two components correlate with the arthritic disease state of a joint.

Arthritis, Rheumatoid↗
PubMed1996

Benign prostatic hyperplasia in an unselected community-based population: a survey of urinary symptoms, bothersomeness and prostatic enlargement.

OBJECTIVES: To determine the prevalence of (anatomical) benign prostatic hyperplasia/enlargement (BPH/BPE) in an unselected population and to assess the relationships between BPE, urinary flow rates (UFRs) and symptoms in men with BPH. SUBJECTS AND METHODS: All men aged 40-79 years and living in three ex-mining villages in Scotland were invited to undergo a measurement of UFR, transrectal ultrasonography (TRUS) and to complete a symptom score and a previously validated lifestyle questionnaire. RESULTS: Of 597 eligible men, 367 (61%) completed the urinary symptom questionnaire and 310 (52%) underwent TRUS and measurement of UFR. The response rate in the age group 50-69 was > 60%. Age-specific prevalence rates for BPE (prostate size > 20 g) per 1000 men were: 40-49 years, 615; 50-59 years, 776; 60-69 years, 892; and 70-79 years, 889, giving an overall rate for all ages of 765. There was no significant relationship between prostate size and symptoms, nor between size and peak UFR, nor any clear association between size and interference with activities of daily living. However, men with a UFR of > 20 mL/s were very unlikely to have prostates > 40 g. Relationships were found between some urinary symptoms and UFR. Age, weight and the level of prostate-specific antigen (PSA) were the only independent variables associated with prostate size. CONCLUSION: Compared to published studies, BPE was substantially more prevalent than assumed previously. This study further reinforces the need for the subtle and detailed evaluation of patients who have a syndrome of BPH in assigning them to intervention, be it medical or surgical, or non-intervention/watchful waiting.

Adult↗