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PubMedDate not supplied

Intrapartum nursing: integrating Rubin's framework with social support theory.

Numerous studies and articles on labor support have focused on the potential for improved labor and birth outcomes from supportive care during labor. Despite increased attention to labor support research, surprisingly little has been written about the theoretical underpinnings for intrapartum nursing care. This article explores Reva Rubin's framework and social support theory as a foundation for intrapartum nursing care. The most common features of social support provided the structure into which Rubin's descriptions of nursing care during labor and birth could be evaluated. Social support theory fit remarkably well, both with Rubin's views of the role of the perinatal nurse and with Rubin's observations of mothers' needs and feelings during childbirth. Combining these theoretical frameworks provides a perspective of intrapartum nursing practice that has not been previously considered in the published literature.

Female↗

PubMed2002

Comprehensive banking of sibling donor cord blood for children with malignant and nonmalignant disease.

Banking of cord blood (CB) for unrelated hematopoietic stem cell (HSC) transplantation is well established. However, directed-donor banking of CB for siblings in a current good tissue practices (cGTP) environment has not previously been investigated. Families were eligible for the present study if they were caring for a child with a disorder treatable by HSC transplantation and expecting the birth of a full sibling. We devised standard operating procedures and policies to address eligibility, donor recruitment, donor and recipient evaluation, CB collection, shipping, graft characterization, storage, and release of CB from quarantine. Many of these policies are distinctly different from those established for unrelated-donor CB banks. We enrolled 540 families from 42 states. Collections occurred at several hundred different hospitals. No family was deferred on the basis of health history or infectious disease testing, but departures from standard donor suitability criteria were documented. Disease categories for sibling recipients included malignancy, sickle cell anemia, thalassemia major, nonmalignant hematological conditions, and metabolic errors. Mean CB volume (including anticoagulant) was 103.1 mL; mean nucleated cell count was 8.9 x 10(8). Cell dose exceeded 1.5 x 10(7) nucleated cells per kilogram for 90% of banked units. Seventeen units (3.4%) have been transplanted. Sixteen of the 17 CB allograft recipients had stable engraftment of donor cells. Remote-site collection of sibling donor CB can be accomplished with a high success rate and in a cGTP-guided environment. The cellular products have been used successfully for transplantation; their number and characteristics should be adequate to support the first prospective clinical investigations of sibling CB transplantation.

Adolescent↗

PubMed2005

Illegal births and legal abortions--the case of China.

BACKGROUND: China has a national policy regulating the number of children that a woman is allowed to have. The central concept at the individual level application is "illegal pregnancy". The purpose of this article is to describe and problematicize the concept of illegal pregnancy and its use in practice. METHODS: Original texts and previous published and unpublished reports and statistics were used. RESULTS: By 1979 the Chinese population policy was clearly a policy of controlling population growth. For a pregnancy to be legal, it has to be defined as such according to the family-level eligibility rules, and in some places it has to be within the local quota. Enforcement of the policy has been pursued via the State Family Planning (FP) Commission and the Communist Party (CP), both of which have a functioning vertical structure down to the lowest administrative units. There are various incentives and disincentives for families to follow the policy. An extensive system has been created to keep the contraceptive use and pregnancy status of all married women at reproductive age under constant surveillance. In the early 1990s FP and CP officials were made personally responsible for meeting population targets. Since 1979, abortion has been available on request, and the ratio of legal abortions to birth increased in the 1980s and declined in the 1990s. Similar to what happens in other Asian countries with low fertility rates and higher esteem for boys, both national- and local-level data show that an unnaturally greater number of boys than girls are registered as having been born. CONCLUSION: Defining a pregnancy as "illegal" and carrying out the surveillance of individual women are phenomena unique in China, but this does not apply to other features of the policy. The moral judgment concerning the policy depends on the basic question of whether reproduction should be considered as an individual or social decision.

Journal Article↗

PubMed2002

Attitudes toward tuberculosis of final year medical students from Canada, India, and Uganda.

BACKGROUND: Tuberculosis, although both preventable and treatable, continues to be the world's leading cause of death from an infectious agent. PURPOSE: To extend the results of our previous study of knowledge and practices of final year medical students regarding tuberculosis at three medical schools from endemic and nonendemic areas and to describe their attitudes. METHODS: Eight statements assessing attitudes, as part of a larger survey, were administered to final year medical students at McMaster University in Canada, Christian Medical College in India, and Makerere University in Uganda. RESULTS: One hundred sixty surveys were returned with 155 completed attitude responses. The response rate was 68.4% (65 of 95) for McMaster University, 39.7% (23 of 58) for the Christian Medical College, and 78.3% (72 of 92) for Makerere University. Analysis showed that six of eight attitude items were slightly statistically different among the schools with minimal effect of curriculum time and patient exposure. CONCLUSIONS: Despite quite varied exposure to tuberculosis, students from endemic and nonendemic areas responded similarly on statements addressing attitudes toward tuberculosis.

Awareness↗

PubMed2006

Emergency dental clinic patients in South Devon, their anxiety levels, expressed demand for treatment under sedation and suitability for management under sedation.

OBJECTIVE: To assess the anxiety levels of patients attending two salaried dental service emergency clinics, their expressed demand for treatment under sedation, and their medical suitability for dental sedation. DESIGN: A questionnaire survey, incorporating the Modified Dental Anxiety Scale (MDAS) and assessment of American Society of Anesthesiologists' (ASA) physical status classification, of all adult patients attending two emergency dental clinics in Torquay and Newton Abbot. RESULTS: 513 patients returned questionnaires. Only five declined to take part in the study. The mean MDAS for patients attending the two emergency dental clinics was 14.09 (SD 6.04) and 41.9% of patients were classified as dentally anxious (MDAS >15). A preference for treatment under sedation was expressed by 56.3%, of all patients, of whom 50.5% were classified as ASA 1 (without health problems) and would have been suitable for sedation in primary dental care. CONCLUSIONS: The reported dental anxiety levels of patients attending the two emergency dental clinics were found to be much higher than those found by previous studies in general dental practice and at dental school emergency clinics. There was a high expressed demand for treatment under sedation. Further studies are needed to assess the levels of dental anxiety seen at other dental emergency clinics and a health needs assessment to determine need as opposed to expressed demand.

Adolescent↗

PubMed1992

The receptive communication abilities of deaf students under oral, manual, and combined methods.

Two groups of severely and profoundly deaf students aged 10 to 17 years were tested on their abilities to choose, from a set of four pictures, the one matching a sentence presented on videotape under 11 different communication conditions. The communication conditions involved individual and combined presentations of lipreading, listening, fingerspelling, and signed English. Severely deaf students scored higher than profoundly deaf students under all conditions except those that involved signed English, where the profoundly deaf group scored as high as the severely deaf group. All the students scored higher under conditions that involved audition, including lipreading plus audition, than under audition alone. The discussion of the results highlights methodological problems that made it difficult to interpret some previous studies in this area. Practical implications of the results for both oral education of the deaf and simultaneous communication are also discussed.

Adolescent↗

PubMed2002

Deriving wavelength spectra from fringe images from a fixed-gap single-etalon Fabry-Perot spectrometer.

A new method is described for inferring wavelength spectra from two-dimensional images of Fabry-Perot interference fringes. This new method addresses the practical difficulties that have been previously encountered in determining the fringe image's center, magnification, and distortions accurately enough to fully exploit the spectral resolution provided by the etalon. The method proceeds in two steps. First, the instrument's mapping of image position to interference order is characterized by use of images of a scene illuminated uniformly by a highly monochromatic laser. Then this information is applied to resample two-dimensional images of unknown radiation sources down to sets of one or more one-dimensional wavelength spectra. Discrete cross-correlation techniques are used at both stages of anal-

Journal Article↗

PubMed2004

Author self-citation in the diabetes literature.

BACKGROUND: Author self-citation is the practice of citing one's previous publications in a new publication. Its extent is unknown. We studied author self-citation, choosing the major clinical field of diabetes mellitus to represent the general medical literature. METHODS: We identified every article about diabetes mellitus in 170 hand-searched clinical journals published in 2000. For every article, we recorded the bibliographic citation and publication type (original or review article) and assessed the methodologic rigour. Citation information was obtained from the ISI Web of Knowledge in April 2003. RESULTS: Of 49,028 articles, 289 were about diabetes mellitus and had citation information. Citation counts ranged from 0 to 347 (median 6, interquartile range [IQR] 2-12). Author self-citation counts ranged from 0 to 16 (median 1, IQR 0-2). Author self-citations accounted for an average of 18% (95% confidence interval [CI] 15%-21%) and a median of 7% (95% CI 5%- 11%) of all citations of each publication that was cited at least once (n = 266). Original articles had double the mean proportion of author self-citations compared with review articles (19% v. 9%; median 7% v. 0%, difference 7%, 95% CI 0- 10%). Methodologic rigour and review type were not significantly associated with subsequent author self-citation. INTERPRETATION: Nearly one-fifth of all citations to articles about diabetes mellitus in clinical journals in the year 2000 were author self-citations. The frequency of self-citation was not associated with the quality of publications. These findings are likely applicable to the general clinical medicine literature and may have important implications for the assessment of journal or publication importance and the process of scientific discovery.

Authorship↗

PubMed2003

Race/ethnicity and asthma among children presenting to the emergency department: differences in disease severity and management.

OBJECTIVE: To investigate racial/ethnic differences in acute asthma among children who present to the emergency department (ED). METHOD: We analyzed data from 2 prospective cohort studies performed during 1997-1998 as part of the Multicenter Airway Research Collaboration. Using a standardized protocol, researchers at 40 EDs in 18 US states provided 24-hour-per-day coverage for a median of 2 weeks per year. Children with acute asthma were interviewed in the ED and by telephone 2 weeks after discharge. RESULTS: Among 1095 patients, 679 (62%) were black, 256 (23%) were Hispanic, and 160 (15%) were white. Black and Hispanic children had greater histories of lifetime (63%, 64%, 46%) and past-year (34%, 31%, 14%) hospitalization and more ED visits in the past year (medians: 2, 3, 1). Asthma severity at ED presentation, ED management and course, hospitalization during the index visit, discharge prescriptions, and postdischarge outcomes were equivalent among all race/ethnic groups. CONCLUSION: Despite pronounced race/ethnicity-based differences in chronic asthma, all racial/ethnic groups exhibited similar acute asthma severity, ED management, and course. However, given that black and Hispanic children exhibited much higher admission histories and past ED use, the equivalence in inhaled corticosteroid prescriptions on discharge is a disconcerting pattern that mirrors previous literature on outpatient prescription practices. In addition to barriers attributable to socioeconomic factors, health care providers and policy makers should target equalizing deficiencies in preventive medication prescription practices.

Acute Disease↗

PubMedDate not supplied

[Process assessment of health care: Adequacy of the diabetes mellitus treatment in Pelotas, Southern Brazil].

A study was conducted in 1998 with the aim of assessing adequacy of clinical management of diabetic patients attending public health services in Pelotas, Brazil. Patients were interviewed to gather data on medical consultation, disease, and treatment. Data analysis focused on the "type of treatment" variable with three categories: diet, physical activity, and drug treatment. Seventy-six percent of the patients reported having received nutritional orientation. Only 50% of them reported having followed their diet during the preceding 15 days. Also, 75% of patients reported having received recommendations to perform physical activity. However, only one third had practiced some exercise in the previous month. Among 377 interviewed, 289 (77%) were on medication, and among the patients taking oral hypoglycemic agents many had at least one contraindication. The article discusses the need to enhance physicians' adherence to scientific guidelines for diabetes management.

Adolescent↗

PubMed1981

The contribution of school health education to community health promotion: what can we reasonably expect?

Evaluative studies of outcomes of traditional school health education programs have shown that they are very effective in increasing knowledge, somewhat effective in improving attitudes, and, with few notable exceptions, generally ineffective in changing health practices. This paper discusses the previous reviews of the literature of outcomes of school health education programs, and discusses the constraints inherent in school-based activities; an emphasis on cognitive learning, lecture-oriented teaching methods, inadequate pupil assessment procedures, a captive audience, competing subject areas, competing behavioral influences, behavior change attempts directed at ingrained health habits, inadequate coordination with community resources, and lack of consensus regarding educational goals. The paper then examines several recent successful school health education programs emphasizing non-traditional approaches in self-initiated care, pregnancy prevention, smoking prevention, and nutrition. It is concluded that school-based health education programs have three important roles in community health promotion: 1. the provision of a fundamental understanding of health and disease concepts to large segments of the population; 2. the reinforcement of positive health attitudes; and 3. the alteration of concurrent health behaviors for significant health problems. Although school health education may be helpful in enhancing decision-making and social interaction skills, little empirical evidence exists at this time to support this conclusion.

Curriculum↗

PubMed2004

Efficacy and safety of donepezil in patients with Alzheimer's disease: results of a global, multinational, clinical experience study.

BACKGROUND: Donepezil has consistently been shown to be effective and well tolerated in the symptomatic treatment of Alzheimer's disease in placebo-controlled clinical trials. It has been shown to provide significant benefits in cognition, global function and activities of daily living in patients with mild-to-moderate Alzheimer's disease. However, in order to control for confounding factors, some clinical trials of donepezil have excluded patients with comorbid illness and concomitant medication use. OBJECTIVE: The objective of this study was to evaluate the efficacy, tolerability and safety of donepezil in a wider and more diverse sample of patients and centres than previous trials, reflecting routine clinical practice. METHODS: In this 12-week, open-label, multicentre trial, patients with probable mild-to-moderate Alzheimer's disease received donepezil 5 mg/day for 28 days, after which the dosage was increased to 10 mg/day according to the investigating clinician's judgement. Patients were enrolled at 246 study centres in 18 countries worldwide. Cognition was assessed by a trained clinician using the Mini-Mental State Examination (MMSE) at baseline, week 4 and week 12 (or last visit). Changes in patient activity and social interaction were evaluated using a caregiver diary. Each week, caregivers recorded their impression of change compared with baseline on three aspects of patient behaviour using a 5-point scale. Efficacy analyses were performed on the intent-to-treat population. Significance was determined using the paired t-test (0.05 significance level). Tolerability and safety were assessed by monitoring adverse events, physical examinations, vital signs, clinical laboratory test abnormalities and ECG findings throughout the study. RESULTS: A total of 1113 patients received donepezil (mean baseline MMSE score [+/-SD] 18.74 +/- 5.21). 989 (88.9%) patients completed the study; 59 (5%) patients discontinued because of adverse events. Most patients were taking at least one concomitant medication (n = 802; 72%) and had at least one comorbid medical condition (n = 745; 67%) on study entry. Donepezil significantly improved cognition compared with baseline at weeks 4 and 12, and at week 12 using a last observation carried forward (LOCF) analysis (all p < 0.0001). Mean change from baseline MMSE score (+/-SE) at week 12-LOCF was +1.73 +/- 0.10. Donepezil was also associated with significant improvements in patient social interaction, engagement and interest, and initiation of pleasurable activities at all weekly assessments and week 12-LOCF (all p < 0.0001). Donepezil was generally well tolerated; adverse events were consistent with the known safety profile of donepezil. CONCLUSION: Donepezil treatment resulted in statistically significant improvements in cognition and patient activity and social behaviour, and was generally well tolerated despite high levels of comorbid illness and concomitant medication use. The results of this open-label study in a large patient population are consistent with those from controlled trials and support that donepezil is effective in the treatment of mild-to-moderate Alzheimer's disease in everyday practice.

Adult↗

PubMed1995

Cost and quality effects of treating erosive oesophagitis. A re-evaluation.

The objective of this study was to re-evaluate the clinical and economic effects of common therapies for erosive oesophagitis in the light of a newly approved treatment regimen. A previously constructed 7-month community practice decision analytical model was revised to include the latest published data on efficacy and symptomatic outcomes. The original results of phase I therapy (antacids plus dietary, sleeping and lifestyle changes) alone or combined with ranitidine 150mg bid or omeprazole 20mg od were reassessed by adding new clinical data on the efficacy of and symptomatic response to ranitidine 150mg qid. The same payment data used in the first analysis were applied here as well, with the addition of the US price of ranitidine 150mg qid. The study perspective was that of the payer or insurer. Omeprazole-based therapy remained a dominant strategy for symptomatic care during the 7-month model. It was 14% less costly per patient, led to 23% fewer symptomatic months, and had 21% lower cost per symptom-free month than ranitidine 150mg qid, the next best alternative. Evolving treatment strategies necessitate rapid assessment and reassessment so that clinical practice can remain current, patients can be assured of the best quality, and insurers can be aware of treatment cost and budgetary impact given limited resources in all countries. Only by consistent and continuous re-evaluation of new or changing medical interventions can clinicians and insurers adapt patient management to new scientifically derived results. This is the best manner by which to meet patients' care needs and the clinical needs of practitioners, as well as the financial needs of payers.

Antacids↗

PubMed2005

[External transluminal drainage of the pancreatic duct due to fistula caused by post biopsy pancreatic necrosis].

BACKGROUND: Pancreatic fistulas are not frequent after the needle biopsy of the pancreatic head. The aim was to present a patient with this type of fistula who was managed using the surgical method never previously applied in our surgical practice. CASE REPORT: In our patient, pancreatic fistula appeared at the site of the needle biopsies due to the development of the necrosis. Since the conservative treatment with octreotide and the total parenteral nutrition were without result, we turned to the surgical treatment by placing a silicone prosthesis along the pancreatic duct into the duodenum, next through the Roux-en-Y flexure to provide the external drainage of a pancreatic juice. Postoperatively, applying the conservative treatment, pancreatic fistula disappeared, and a silicone prosthesis was removed three weeks later. CONCLUSION: The described surgical procedure can be successful i managing fistulas which occur after the pancreatic necrosis.

Biopsy, Needle↗

PubMed1994

Effect of body weight on net energy value of feeds for growing pigs.

Digestible (DE), metabolizable (ME), and net (NE) energy values of seven diets were measured in castrated male pigs of 45 (Stage 1), 100 (Stage 2), or 150 (Stage 3) kg BW. Diets were prepared from a basal diet supplemented with cornstarch, or sucrose, or a protein mixture (referred to here as protein), or rapeseed oil, or a mixture of fibrous ingredients (referred to as fiber), or rapeseed oil+fiber. Diets were fed at similar levels (x maintenance) at the three stages. Heat production at different feeding levels, as measured by indirect calorimetry, allowed calculation of energy retained by each pig (equal to ME intake minus heat production) and an estimate of fasting heat production of all pigs (360 kcal/kg BW.42). Net energy intake was then calculated for each pig as retained energy plus 360 x BW.42. The amounts of DE digested before the end of the ileum (DEi) and in the hindgut (DEh) were measured. Formulation of diets allowed calculation of energy values of the ingredients added to the basal diet. Digestibility and metabolizability of diets increased significantly from Stages 1 to 3, with higher variations for low-energy diets. The NE:ME ratio (k, %) and dietary NE content were not affected (P > .05) by stage of growth. On average, k was 75%, with higher values for diets containing rapeseed oil or starch (77%) and lower estimates for the fiber diet (72%). As a consequence, k was approximately 90, 82, 80, 72, and 60% for rapeseed oil, cornstarch, sucrose, protein, and fiber, respectively. These values are consistent with the lower k value for ME from DEh (57 vs 78% for DEi). Present data confirm that the hierarchy between feeds is dependent on the energy system (DE vs ME vs NE) and that the NE concept is superior in predicting the "true" energy value. The present results combined with previous ones show that, under practical conditions, the same NE prediction equations based on digestible nutrient contents, or preferably DE or ME contents, can be applied at all stages of growth in pigs. However, attention should be paid to factors such as BW or feeding level that affect digestibility and metabolizability of feeds markedly. The effects are the most important for ingredients.

Animal Feed↗

PubMed2005

Vegetation management to stimulate denitrification increases mosquito abundance in multipurpose constructed treatment wetlands.

Inundation of dried emergent vegetation that has been knocked down using heavy equipment is a vegetation management strategy that provides an inexpensive source of supplemental organic carbon to stimulate denitrification, a process important for nitrate removal in constructed treatment wetlands. The abundance of larval mosquitoes (Culex sp. and Culiseta sp.) in multipurpose constructed wetlands that had undergone autumnal vegetation management intended primarily to enhance denitrifying bacteria was significantly higher than in wetlands that remained in continuous operation. Mosquito abundance in wetlands that had undergone vegetation management during autumn was much lower than that observed during spring in a previous study; nevertheless, vegetation management practices that inundate dried, felled macrophytes are contraindicated for mosquito control.

Animals↗

PubMed2006

Joint inspection of services for people with learning disabilities in Scotland: compliance or commitment?

PURPOSE: The article describes the development of a practical model of joint, integrated inspection of managed care services for people with learning disabilities in Scotland. The model will give a reliable measure of the impact services are making to people's lives and the quality of service that individuals are actually receiving. CONTEXT OF CASE: At present health, social services and education services for people with learning disabilities in Scotland are inspected separately, by up to nine different agencies. The first joint, integrated inspections of all services for people with learning disabilities in Scotland will take place in 2006. This is the first inspection of its kind in the UK, and the first to involve carers and people with learning disabilities on the inspection team. DATA SOURCES: Quality Outcome Indicators were developed in 21 different areas, or domains. Evidence based best practice, and evaluative data from previous inspections were the primary sources of data. CASE DESCRIPTION: This paper reviews the background and rationale for the integrated, joint inspection process. Strengths and constraints of this approach to inspection are discussed, including the crucial importance of commitment from services and from inspectors, rather than mere compliance with demands. Some guidance on how to fully involve staff, carers and services users in the inspection process is given. CONCLUSIONS AND DISCUSSION: The model will produce data to inform decision-making for managers in integrated services and give services users clear information about how well local needs are being met, what areas need development, and what capacity the organisations have to improve. The model of inspection may be of interest to practitioners in a national and international context. The model will be evaluated, following the first joint inspection.

Journal Article↗

PubMed2000

Atypical epithelial cells and specimen adequacy: current laboratory practices of participants in the college of American pathologists interlaboratory comparison program in cervicovaginal cytology.

CONTEXT: The Bethesda System for reporting cervical/vaginal cytologic diagnoses introduced terminology for atypical squamous and glandular cells and categories for specimen adequacy. OBJECTIVES: To analyze current laboratory reporting practices and compare trends to previous surveys. DESIGN: Questionnaire surveys were mailed to 2000 laboratories in 1996 and 1997. PARTICIPANTS: Laboratories enrolled in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology. MAIN OUTCOME MEASURES: Laboratory policies, criteria, and reporting rates for Bethesda System categories. RESULTS: The 1996 specimen adequacy survey had 1166 respondents, and 768 laboratories returned the 1997 questionnaire focusing on atypical squamous cells of undetermined significance (ASCUS) and glandular cells of undetermined significance (AGUS). Nearly all laboratories (92%) routinely reported specimen adequacy, an increase from the 66% rate in 1991. The median rate for unsatisfactory specimens was 0.5% (mean 0.95%), and the median rate for the satisfactory but limited category was 5.8% (mean 9.3%). The Bethesda criteria for designating a specimen unsatisfactory were used by more than 90% of laboratories. Nearly all laboratories (97%) used the term ASCUS in 1997, and more than 80% of laboratories used the Bethesda criteria for this category. Median reporting rates for epithelial abnormalities were as follows: ASCUS, 4.5%; AGUS, 0.3%; low-grade squamous intraepithelial lesion (SIL), 1.6%; and high-grade SIL, 0.5%. The median ASCUS/SIL ratio was 2.0, with 80% of laboratories reporting ratios between 0.64 and 4.23. The median ASCUS rate and ASCUS/SIL ratio were higher than 1993 survey results. Nearly all laboratories attempted follow-up studies on patients with abnormal cytology results, and midsized laboratories achieved the highest rates of follow-up. Median rates of abnormalities following an ASCUS or AGUS diagnosis were 20% and 15%, respectively. Laboratory respondents commonly used written recommendations in ASCUS/AGUS reports. CONCLUSIONS: Most laboratories that responded to the surveys had adopted Bethesda terminology and criteria for specimen adequacy and ASCUS/AGUS. Reporting rates for SIL and adequacy categories have remained stable, but median ASCUS rates and ASCUS/SIL ratios are higher than in 1993. The AGUS category is reported infrequently, but can be associated with significant pathology.

Clinical Laboratory Techniques↗