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1.
Neurology ; 64(9): 1548-52, 2005 May 10.
Article in English | MEDLINE | ID: mdl-15883315

ABSTRACT

OBJECTIVE: The authors evaluated 3,375 participants without dementia at the time of MRI in 1991 to 1994 over 5.7 years for incident dementia and type of dementia. METHODS: Incidence of and risk factors for vascular dementia (VaD) were measured using both pre-MRI and modified State of California Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC) post-MRI review and further classified Alzheimer disease (AD) by the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria. RESULTS: Approximately 44% (213) of 480 incident dementia cases were classified as possible or probable VaD by ADDTC. The incidence of VaD increased with age and was greater in blacks than whites. Risk factors for VaD included age, Modified Mini-Mental State Examination, high white matter grade, number of MRI infarcts, ventricular size, and history of stroke. CONCLUSIONS: Vascular disease in the brain is prevalent among incident dementia cases. There is a substantial overlap between cases classified as Alzheimer disease by Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association and vascular dementia (VaD) by modified State of California Alzheimer's Disease Diagnostic and Treatment Centers criteria. The substantial contribution of vascular disease would be missed without inclusion of MRI. Treatment of risk factors for VaD could have an important impact on incidence of dementia.


Subject(s)
Brain/pathology , Cerebral Arteries/pathology , Dementia, Vascular/epidemiology , Dementia, Vascular/pathology , Age Factors , Aged , Aged, 80 and over , Alzheimer Disease/epidemiology , Alzheimer Disease/pathology , Alzheimer Disease/physiopathology , Atrophy/etiology , Atrophy/pathology , Atrophy/physiopathology , Brain/blood supply , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/pathology , Cardiovascular Diseases/physiopathology , Cerebral Arteries/physiopathology , Cerebral Infarction/epidemiology , Cerebral Infarction/pathology , Cerebral Infarction/physiopathology , Cohort Studies , Comorbidity/trends , Dementia, Vascular/physiopathology , Female , Humans , Lateral Ventricles/pathology , Lateral Ventricles/physiopathology , Magnetic Resonance Imaging , Male , Nerve Fibers, Myelinated/pathology , Neuropsychological Tests , Racial Groups , Risk Factors , Sex Factors
2.
Neurology ; 63(12): 2341-7, 2004 Dec 28.
Article in English | MEDLINE | ID: mdl-15623697

ABSTRACT

OBJECTIVE: To determine if individuals ultimately diagnosed with Alzheimer disease (AD) exhibited evidence of cognitive impairment on neuropsychological tests administered between 1.5 years and 8.1 years before dementia onset. METHODS: A total of 693 community-dwelling individuals, part of the Cardiovascular Health Study, completed a neuropsychological test battery in 1991/92. Subjects were followed annually over the next 8 years (median follow-up = 7.4 years). Seventy-two individuals were ultimately diagnosed with AD (median follow-up = 4.5 years): 24 with AD onset 1.5 to 3.4 years after baseline neuropsychological testing, 20 with AD onset 3.5 to 5.0 years after testing, and 28 with onset 5.1 to 8.1 years after testing. A total of 621 individuals remained nondemented throughout the 8 years of follow-up (median follow-up = 7.5 years). RESULTS: Subjects ultimately diagnosed with AD had poorer scores on baseline neuropsychological measures than subjects who remained nondemented. Although individuals closest to AD onset (i.e., 1.5 to 3.4 years) performed the most poorly, cognitive impairment was detected in individuals who did not develop AD until 5 to 8 years later. CONCLUSIONS: Cognitive changes can be detected well before onset of Alzheimer disease.


Subject(s)
Alzheimer Disease/diagnosis , Cognition Disorders/diagnosis , Neuropsychological Tests , Age of Onset , Alzheimer Disease/epidemiology , Alzheimer Disease/psychology , Cardiovascular Diseases/epidemiology , Cognition Disorders/psychology , Cohort Studies , Confounding Factors, Epidemiologic , Disease Progression , Early Diagnosis , Educational Status , Female , Follow-Up Studies , Humans , Male , Memory Disorders/diagnosis , Memory Disorders/psychology , Predictive Value of Tests , Proportional Hazards Models , Risk , Sensitivity and Specificity , Time Factors
3.
Neurology ; 57(7): 1222-9, 2001 Oct 09.
Article in English | MEDLINE | ID: mdl-11591840

ABSTRACT

BACKGROUND: Silent infarcts are commonly discovered on cranial MRI in the elderly. OBJECTIVE: To examine the association between risk of stroke and presence of silent infarcts, alone and in combination with other stroke risk factors. METHODS: Participants (3,324) in the Cardiovascular Health Study (CHS) without a history of stroke underwent cranial MRI scans between 1992 and 1994. Silent infarcts were defined as focal lesions greater than 3 mm that were hyperintense on T2 images and, if subcortical, hypointense on T1 images. Incident strokes were identified and classified over an average follow-up of 4 years. The authors evaluated the risk of subsequent symptomatic stroke and how it was modified by other potential stroke risk factors among those with silent infarcts. RESULTS: Approximately 28% of CHS participants had evidence of silent infarcts (n = 923). The incidence of stroke was 18.7 per 1,000 person-years in those with silent infarcts (n = 67) compared with 9.5 per 1,000 person-years in the absence of silent infarcts. The adjusted relative risk of incident stroke increased with multiple (more than one) silent infarcts (hazard ratio 1.9 [1.2 to 2.8]). Higher values of diastolic and systolic blood pressure, common and internal carotid wall thickness, and the presence of atrial fibrillation were associated with an increased risk of strokes in those with silent infarcts (n = 53 strokes). CONCLUSION: The presence of silent cerebral infarcts on MRI is an independent predictor of the risk of symptomatic stroke over a 4-year follow- up in older individuals without a clinical history of stroke.


Subject(s)
Cerebral Infarction/diagnosis , Cerebral Infarction/epidemiology , Magnetic Resonance Imaging , Stroke/diagnosis , Stroke/epidemiology , Aged , Cohort Studies , Female , Follow-Up Studies , Humans , Incidence , Male , Predictive Value of Tests , Risk Factors
4.
Chronic Dis Can ; 20(3): 118-26, 1999.
Article in English | MEDLINE | ID: mdl-10557202

ABSTRACT

This study examines eight measures of mental health and looks for associations with nine potential demographic and psychosocial determinants. Data from the National Population Health Survey (NPHS), analyzed by logistic regression, reveal consistently strong, graded, independent associations of current stress, social support, life events, education and childhood traumas with both positive and negative indicators of mental health status. Sex differences exist for four of eight measures. For most indicators, mental health is relatively poor among youth and improves with age. Physical and mental health problems are associated. There is no independent relation between mental health and income adequacy or province of residence. Two measures used in several previous Canadian surveys are recommended for inclusion in the NPHS to better monitor population mental health.


Subject(s)
Mental Health , Adolescent , Adult , Aged , Canada , Depression , Female , Happiness , Health Surveys , Humans , Male , Middle Aged , Self Concept
5.
Nurs Diagn ; 10(4): 137-47, 1999.
Article in English | MEDLINE | ID: mdl-10786554

ABSTRACT

PURPOSE: To investigate factors associated with nursing diagnosis utilization. METHODS: A retrospective chart audit was conducted on four hospital units over a 5-month period and linked to the nurses (N = 65) who participated in a survey on attitudes toward nursing diagnosis. FINDINGS: Computer-generated nursing care plans resulted in the greatest frequency of nursing diagnosis documentation. Nurses who did not document nursing diagnoses, and nurses employed in hospitals without nursing diagnosis implementation programs, had more positive attitudes toward the value of nursing diagnosis in practice compared with nurses who documented nursing diagnoses and nurses employed in hospitals with implementation programs. CONCLUSIONS: Nurses have a greater tendency to document nursing diagnoses when institutions have formal educational programs and computer-generated care plans.


Subject(s)
Attitude of Health Personnel , Health Knowledge, Attitudes, Practice , Nursing Diagnosis/statistics & numerical data , Nursing Records , Nursing Staff, Hospital/psychology , Adult , Humans , Nursing Audit , Nursing Evaluation Research , Nursing Staff, Hospital/education , Ontario , Patient Care Planning , Retrospective Studies
6.
Arch Environ Health ; 53(3): 190-5, 1998.
Article in English | MEDLINE | ID: mdl-9814714

ABSTRACT

Reported residential fungal contamination has been associated consistently with increased symptoms among occupants; however, an objective measure of a health effect is lacking, and a pathophysiologic mechanism has not been established. Our objective was to determine if exposure to indoor fungal contamination influenced T-cell differentiation. In this study, we contrasted lymphocyte populations, measured by flow cytometry, between a group of children who lived in homes with considerable fungal contamination (n = 39) and a group in less-contaminated homes (n = 20). Indicators of fungal biomass were viable fungi in house dust and air ergosterol in the child's bedroom. Living in a more-contaminated home versus a less-contaminated home was associated with a larger number of CD3+ T cells expressing CD45RO (1.5 x 10(9)/I versus 1.1 x 10(9)/I, respectively; p = .05, two-tailed t testing) and a reduced CD4/CD8 ratio (1.6 versus 1.8, respectively; p = .04). The differences persisted over a 12-mo period, and they were not explained by the child's age or total serum IgE, dust mite antigens, and the presence of furry or feathered pets or a humidifier. The results suggest that residential fungal contamination leads to chronic stimulation of children's lymphocytes.


Subject(s)
Air Microbiology , Air Pollution, Indoor/adverse effects , Fungi/immunology , T-Lymphocyte Subsets/immunology , CD4-CD8 Ratio , Child , Female , Flow Cytometry , Humans , Immunoglobulin E/blood , Lymphocyte Activation/immunology , Lymphocyte Count , Male , Ontario
7.
Can J Public Health ; 89(4): 260-3, 1998.
Article in English | MEDLINE | ID: mdl-9735522

ABSTRACT

OBJECTIVES: To describe: 1) The education of pregnant women by health care professionals about the prevention of preterm birth; and 2) professionals' views about future initiatives. BACKGROUND: A population survey of health professionals was conducted in Eastern Ontario. The response rate was 73% (608/835). RESULTS: Education materials for women receiving prenatal care about the prevention of preterm birth were available from 10% (12/115) of family physicians, 40% (23/58) of obstetricians, 19% (57/306) of labour room nurses and 76% (94/124) of the prenatal teachers. Only one third of physicians routinely discussed the signs and symptoms of preterm labour prior to 20 weeks. Practitioners' future priorities were smoking cessation programs for pregnant women and increased attendance at early prenatal classes. CONCLUSIONS: Most women are not being educated by anyone in the health care team about the prevention of preterm birth. There is a need for multidisciplinary guidelines about the timing and type of information for women about risk reduction and the early identification and treatment of preterm labour.


Subject(s)
Health Personnel/statistics & numerical data , Obstetric Labor, Premature/prevention & control , Patient Education as Topic/statistics & numerical data , Practice Patterns, Physicians' , Prenatal Care/methods , Data Collection , Female , Humans , Male , Ontario , Pregnancy , Prenatal Care/statistics & numerical data
8.
Cancer Chemother Pharmacol ; 40(4): 293-308, 1997.
Article in English | MEDLINE | ID: mdl-9225947

ABSTRACT

OBJECTIVE: To assess factors that affect cisplatin nephrotoxicity. METHODS: In 425 patients treated with cisplatin, we assessed the effect of pretreatment factors and treatment conditions on the rise in serum creatinine with the first course of cisplatin, on the maximum rise in serum creatinine over the entire course of the cisplatin therapy, and on residual nephrotoxicity after the last cisplatin treatment ended. (Because of the nature of the relationship between serum creatinine and creatinine clearance, rise in serum creatinine was divided by pretreatment creatinine squared.) Patients were dichotomized into the upper quartile versus the lower three quartiles of degree of nephrotoxicity. Multivariate analyses were based on logistic regression, controlling for cisplatin dose per course. RESULTS: Controlling for cisplatin dose per course, factors most closely associated with nephrotoxicity during the first course of cisplatin were: serum albumin and potassium, body surface area, and administration of cisplatin over 2-5 days per course vs 1 day (negative associations). Controlling for cisplatin dose per course, the single factor most closely associated with maximum life-time cisplatin nephrotoxicity was concurrent use of a vinca alkaloid (negative association). Controlling for cisplatin dose per course, factors most closely associated with residual nephrotoxicity after the end of cisplatin therapy were cumulative dose of cisplatin, concurrent use of metoclopramide (positive associations), uric acid and concurrent use of phenytoin and a vinca alkaloid (negative associations). The association of nephrotoxicity with uric acid and with body surface area was felt to be an artifact resulting from its positive association with pretreatment serum creatinine. Nephrotoxicity during the first course of cisplatin also correlated significantly with autopsy kidney cortex platinum concentrations in 77 evaluable patients. CONCLUSIONS: (1) While several factors correlated with cisplatin nephrotoxicity, most of the observed nephrotoxicity was not explained by the variables identified. (2) While most patients received intravenous hydration, patients receiving high hydration volumes did not have significantly less nephrotoxicity than patients receiving lower hydration volumes: (3) Of the variables identified, serum albumin, metoclopramide and phenytoin may have affected nephrotoxicity by altering cisplatin uptake into or distribution within the kidney.


Subject(s)
Antineoplastic Agents/adverse effects , Cisplatin/adverse effects , Kidney Diseases/chemically induced , Kidney/drug effects , Neoplasms/drug therapy , Antineoplastic Agents/administration & dosage , Cisplatin/administration & dosage , Creatinine/blood , Female , Humans , Kidney/pathology , Kidney Diseases/pathology , Logistic Models , Male , Neoplasms/blood , Platinum/analysis , Retrospective Studies , Risk Factors
9.
J Mot Behav ; 29(3): 223-9, 1997 Sep.
Article in English | MEDLINE | ID: mdl-12453781

ABSTRACT

In 2 experiments, the effect of active or passive mobility and active or passive choice experiences on children's memory for locations visited while retrieving puzzle pieces hidden in a large room were examined. In the first experiment, fifty-two 6- and 7-year-old children were randomly assigned to 1 of 4 training conditions: active choice-active movement, active choice-passive movement, passive choice-active movement, and passive choice-passive movement. After 3 training trials, all children were tested in the active choice-active movement condition. A 2 (movement) x 2 (choice) factorial multivariate analysis of variance revealed a significant main effect for movement. Children who had moved actively to find the puzzle pieces in the training trials had (a) a greater percentage correct, (b) more correct visits between errors, and (c) a later visit of first error than children who had been passively pushed in a wheelchair. Making active choices in training did not significantly affect performance. A second experiment used identical procedures but tested 32 children with mobility difficulties who regularly used a wheelchair because of either cerebral palsy or spina bifida. Children from this group who moved actively during training to retrieve the puzzle pieces also performed better on testing. Implications of the results for children with disabilities and for developmental theory are discussed.

10.
J Obstet Gynecol Neonatal Nurs ; 25(2): 137-44, 1996 Feb.
Article in English | MEDLINE | ID: mdl-8656304

ABSTRACT

OBJECTIVE: To evaluate the effectiveness of a fetal monitoring education program in increasing nurses' knowledge and clinical skills. DESIGN: Multicenter randomized control trial. SETTING: Twelve hospitals in eastern Ontario, Canada. PARTICIPANTS: One hundred nine volunteer registered nurses randomly assigned, within each hospital, to an experimental (n = 47) or control (n = 62) group. Ninety-six nurses (40 in the experimental group and 56 in the control group) completed the 6-month follow-up (88% retention). INTERVENTIONS: The experimental group participated in a 1-day fetal monitoring workshop and a review session 6 months later. MAIN OUTCOME MEASURES: Performance on a 45-item knowledge test and a 25-item skills checklist. The passing score was at least 75% correct on each test. RESULTS: The percentage of nurses in the experimental group passing both the knowledge and the clinical skills tests after the workshop was significantly higher (p < 0.01) than that of the nurses in the control group: 68.1% versus 6.5%, respectively. A large difference between the groups remained at the 6-month follow-up (experimental, 45%; control, 6.5%). The performance of the nurses in the experimental group improved to an 85% pass rate after they attended the 6-month review session. CONCLUSION: This comprehensive, research-based program is effective in increasing fetal monitoring knowledge and clinical skills.


Subject(s)
Education, Nursing, Continuing , Fetal Monitoring/nursing , Analysis of Variance , Educational Measurement/methods , Female , Humans , Ontario , Pregnancy , Program Evaluation
11.
Can J Public Health ; 86(1): 37-41, 1995.
Article in English | MEDLINE | ID: mdl-7728714

ABSTRACT

Maternal smoking is the most prevalent risk factor for low birthweight in Canada. This study compared the prevalence of maternal smoking before and during pregnancy from 1983 to 1992. Population-based surveys of 3,296 women during six months in 1983 and 7,940 women during 12 months in 1992 were conducted in Ottawa-Carleton using a self-administered questionnaire completed in the hospital postpartum period. The proportion of women smoking after the first trimester of pregnancy decreased from 28.5% in 1983 to 18.7% in 1992. This difference was due mainly to a reduction in the proportion of women who smoked before pregnancy (37.4% to 26.4%). Another factor was that more women stopped smoking early in pregnancy (23.9% to 29.2%). Gradients in levels of smoking by age, education, marital status and poverty level still exist; however, this is true for the general population. Programs to decrease smoking in pregnancy should continue to focus on reducing smoking among women in general and among those in the preconception and early stages of pregnancy in particular.


Subject(s)
Pregnancy Complications/epidemiology , Smoking/epidemiology , Adolescent , Adult , Female , Humans , Ontario/epidemiology , Population Surveillance , Pregnancy , Prevalence , Smoking/trends , Smoking Cessation/statistics & numerical data , Surveys and Questionnaires
12.
JAMA ; 272(2): 122-4, 1994 Jul 13.
Article in English | MEDLINE | ID: mdl-8015121

ABSTRACT

OBJECTIVE: To describe the pattern over time in the level of statistical power and the reporting of sample size calculations in published randomized controlled trials (RCTs) with negative results. DESIGN: Our study was a descriptive survey. Power to detect 25% and 50% relative differences was calculated for the subset of trials with negative results in which a simple two-group parallel design was used. Criteria were developed both to classify trial results as positive or negative and to identify the primary outcomes. Power calculations were based on results from the primary outcomes reported in the trials. POPULATION: We reviewed all 383 RCTs published in JAMA, Lancet, and the New England Journal of Medicine in 1975, 1980, 1985, and 1990. RESULTS: Twenty-seven percent of the 383 RCTs (n = 102) were classified as having negative results. The number of published RCTs more than doubled from 1975 to 1990, with the proportion of trials with negative results remaining fairly stable. Of the simple two-group parallel design trials having negative results with dichotomous or continuous primary outcomes (n = 70), only 16% and 36% had sufficient statistical power (80%) to detect a 25% or 50% relative difference, respectively. These percentages did not consistently increase over time. Overall, only 32% of the trials with negative results reported sample size calculations, but the percentage doing so has improved over time from 0% in 1975 to 43% in 1990. Only 20 of the 102 reports made any statement related to the clinical significance of the observed differences. CONCLUSIONS: Most trials with negative results did not have large enough sample sizes to detect a 25% or a 50% relative difference. This result has not changed over time. Few trials discussed whether the observed differences were clinically important. There are important reasons to change this practice. The reporting of statistical power and sample size also needs to be improved.


Subject(s)
Publishing/statistics & numerical data , Randomized Controlled Trials as Topic/statistics & numerical data , Publishing/standards , Quality Control , Randomized Controlled Trials as Topic/standards
13.
Cancer Chemother Pharmacol ; 34(1): 14-22, 1994.
Article in English | MEDLINE | ID: mdl-8174197

ABSTRACT

The objective of this study was to determine factors that affect cisplatin concentrations in human kidney cortex. We used flameless atomic absorption spectrophotometry to assay platinum in autopsy specimens of kidney cortex obtained from 83 cisplatin-treated patients. Concentrations were correlated with pretreatment factors and treatment conditions using univariate nonparametric statistics. Hierarchical stepwise multiple regression analyses of transformed (to normalize) data were then used to assess which factors were most important, controlling for other factors. Kidney-cortex platinum concentrations varied from 0 to 14.8 micrograms/g (median, 2.04 micrograms/g). The cumulative lifetime dose of cisplatin ranged from 10 to 1120 mg/m2 (median, 112 mg/m2). The time from the last cisplatin dose to death was < 1-609 days (median, 38 days). According to univariate statistics, factors that correlated (P < 0.05) with kidney-cortex platinum concentrations were the cisplatin dose per course, the pretreatment serum urea level, metoclopramide use (positive correlations), the time from the last cisplatin treatment to death, and the pretreatment serum albumin value (negative correlations). Factors that approached significance (0.05 < or = P < or = 0.10) were a history of hypertension, hyperbilirubinemia (positive), the serum calcium level, and phenytoin use (negative). In the multiple regression analysis, after controlling for the cisplatin dose per course and the time from the last treatment to death, only concurrent metoclopramide and phenytoin use entered the model. The hydration volume did not affect corrected kidney-cortex or kidney-medulla platinum concentrations. The following conclusions were reached: (1) it may be feasible to use lower hydration volumes than those used routinely, (2) any effect of hydration volume on cisplatin nephrotoxicity may not be mediated via a reduction in kidney-cortex platinum concentrations, (3) higher cisplatin doses might be tolerated with new 5-hydroxytryptamine-3 (5HT-3) antiemetics than were tolerated with metoclopramide, and (4) phenytoin should be tested for its ability to reduce cisplatin nephrotoxicity.


Subject(s)
Cisplatin/pharmacology , Kidney Cortex/metabolism , Kidney Medulla/metabolism , Platinum/metabolism , Autopsy , Cisplatin/administration & dosage , Cisplatin/adverse effects , Drug Administration Schedule , Female , Humans , Kidney Cortex/drug effects , Kidney Cortex/pathology , Kidney Medulla/drug effects , Kidney Medulla/pathology , Male , Multivariate Analysis , Survival Rate
14.
Phys Ther ; 73(11): 762-9; discussion 769-70, 1993 Nov.
Article in English | MEDLINE | ID: mdl-8234457

ABSTRACT

BACKGROUND AND PURPOSE: The objectives of this study were (1) to describe the extent to which practicing physical therapists and physical therapy students have reported experiencing inappropriate patient sexual behavior (IPSB), (2) to document the consequences of IPSB, and (3) to identify the strategies the subjects have used to manage IPSB. SUBJECTS AND METHODS: A survey questionnaire was sent to 118 physical therapists and 87 physical therapy students. Completed questionnaires were returned by 74.1% of the subjects (over 70% in each group). RESULTS: The majority of respondents (80.9%) reported having encountered some level of IPSB. Although almost half of the physical therapists and one third of the third- and fourth-year students reported experiencing severe IPSB, including forceful sexual touching and deliberate sexual exposure, only 20% of the respondents perceived that they had been "sexually barassed." Most of the respondents were satisfied with the way in which they handled the IPSB; however, almost 90% considered that in-service and undergraduate education would be desirable. CONCLUSION AND DISCUSSION: It is concluded that this problem should be addressed by further study with a broader sample and by inclusion of these issues in education programs for students and physical therapists.


Subject(s)
Patients , Physical Therapy Modalities/statistics & numerical data , Sexual Harassment/statistics & numerical data , Adult , Documentation , Female , Health Surveys , Humans , Male , Ontario , Physical Therapy Modalities/education , Physical Therapy Modalities/psychology , Sexual Harassment/prevention & control , Sexual Harassment/psychology , Students , Surveys and Questionnaires
15.
Ann Emerg Med ; 22(10): 1524-9, 1993 Oct.
Article in English | MEDLINE | ID: mdl-8214829

ABSTRACT

STUDY OBJECTIVES: The objectives of this study were to determine whether triage nurses using the Brand protocol would order fewer radiographs than would physicians carrying out standard practice procedures, without missing an increased number of joint or bone injuries; the test characteristics and the interobserver reliability of the Brand protocol; and whether having triage nurses order radiographs could reduce total patient waiting time in the emergency department. DESIGN: Randomized, controlled trial. SETTING: The ED of a free-standing children's hospital with approximately 55,000 visits annually. TYPE OF PARTICIPANTS: Children less than 18 years of age who had a history of extremity trauma in the preceding seven days. INTERVENTIONS: Triage nurses applied the Brand protocol to determine the need for a radiograph. MEASUREMENTS AND RESULTS: Of the Brand protocol group, 81.9% had radiographs ordered compared with 87.1% of the control group (P = .03). The percent of positive radiographs was 40.8% in the Brand protocol group compared with 42.6% in the control group (P = .21). There were 3.2% (16) missed radiographic findings in the Brand protocol group compared with none in the control group (P < .001). Patients randomized to the Brand protocol group spent 3.3 hours in the ED compared with 3.6 hours for the control group (P < .001). CONCLUSION: Having triage nurses use the Brand protocol reduced the number of radiographs ordered but at the same time increased the number of missed radiographic findings. However, having triage nurses order radiographs also significantly shortened waiting time in the ED.


Subject(s)
Arm Injuries/diagnostic imaging , Leg Injuries/diagnostic imaging , Triage/methods , Adolescent , Arm Injuries/nursing , Child , Child, Preschool , Clinical Protocols , Emergency Service, Hospital , Hospitals, Pediatric , Humans , Leg Injuries/nursing , Nursing Diagnosis , Observer Variation , Predictive Value of Tests , Radiography/standards , Radiography/statistics & numerical data , Sensitivity and Specificity , Triage/standards
16.
Neonatal Netw ; 12(6): 59-66, 1993 Sep.
Article in English | MEDLINE | ID: mdl-8413140

ABSTRACT

The objectives of this study were to (1) develop a behavioral assessment tool for the measurement of pain in the preterm and full-term neonate; (2) establish the construct and concurrent validity, interrater reliability, and internal consistency of the tool; and (3) examine the relationship between the pain scores and infant characteristics. Thirty-eight infants contributed to the 90 procedures videotaped for the study. The Neonatal Infant Pain Scale (NIPS) was used to score behavioral responses before, during, and after each intrusive procedure. The significant difference in NIPS scores over time indicates that the scale provides a measurement of intensity of infant responses to intrusive procedures. Concurrent validity was established by correlations, ranging from .53 to .84, between NIPS scores at each minute of observation and scores on the Visual Analogue Scale. Interrater reliability was high: Pearson correlations ranged from .92 to .97 across successive minutes of observation. The six component scores of the NIPS had high internal consistency: Cronbach's alphas were .95, .87, and .88 for before, during, and after the procedures, respectively. Although gestational age and five-minute Apgars were positively associated with NIPS scores over time, there was no association between these factors and responsiveness to pain, as measured by change in NIPS scores from before to during the procedure. Results are discussed in terms of the use of the NIPS in clinical trials and its clinical application in a neonatal intensive care unit.


Subject(s)
Infant, Newborn/physiology , Infant, Premature/physiology , Pain Measurement/methods , Apgar Score , Child Behavior , Child, Preschool , Clinical Nursing Research , Gestational Age , Humans , Observer Variation , Reproducibility of Results , Sampling Studies
18.
J Obstet Gynecol Neonatal Nurs ; 21(5): 385-92, 1992.
Article in English | MEDLINE | ID: mdl-1403224

ABSTRACT

OBJECTIVE: To evaluate two nursing approaches to promoting smoking cessation during initial antenatal visits. DESIGN: Experimental, with assignment to interventions using a random, alternate-day strategy and blind assessment of smoking at baseline, 1 month postintervention, 36 weeks' gestation, and 6 weeks postpartum. SETTING/PARTICIPANTS: 224 daily smokers, fewer than 31 weeks gestation, during first prenatal visit, at a teaching hospital antenatal clinic. INTERVENTIONS: An evening class providing guidance on a self-help program for 2 hours on a group basis or 20 minutes on an individual basis during the prenatal appointment. MAIN OUTCOME MEASURE: Smoking cessation, confirmed by urinary cotinine levels. RESULTS: All women assigned to the referral intervention received a referral, but none attended the classes. In contrast, 93% assigned to the immediate intervention received the intervention. The group receiving immediate intervention had two to three times higher rates of cessation at all follow-up periods, with significant differences at the 1-month follow-up. There were certain similarities between the groups. CONCLUSION: Cessation interventions should be administered during the first prenatal visit.


Subject(s)
Obstetric Nursing/methods , Pregnancy , Prenatal Care , Smoking Cessation/methods , Adult , Cotinine/urine , Female , Follow-Up Studies , Humans , Patient Compliance , Program Evaluation , Referral and Consultation
19.
J Med Virol ; 37(1): 48-53, 1992 May.
Article in English | MEDLINE | ID: mdl-1535653

ABSTRACT

Advisory committees recommend hepatitis B (HBV) immunization for professional and student health-care workers. However, the currently licensed vaccines are expensive, and previous surveys have shown that few students (14%) have been immunized in Canada. A low-cost immunization program was offered to health-care students in order to determine whether the effectiveness of HBV immunization could be improved by substantially reducing the vaccine cost to recipients. The immunogenicity, side effects, and 3-dose completion rate of a low-cost Korean HBV vaccine were compared with a similar U.S.-made vaccine. A total of 922 postsecondary students enrolled in 6 health-care disciplines in Ottawa, Canada were surveyed for hepatitis-B immunization status. Nonimmunized students were subsequently offered HBV vaccine at total cost of $15 (Canadian), randomly allocated to receive 3 intramuscular doses of either Korean or U.S.-made plasma-derived HBV vaccine in a double-blind fashion, surveyed about side effects, and tested for hepatitis B surface antibody seroconversion. Only 12% of the 922 surveyed students had been previously immunized when vaccine was obtainable only at high cost. However, 66% of those not immunized participated in the vaccine trial and paid the $15 fee. Hepatitis-B surface antibody seroconversion (greater than or equal to 10 sample ratio units by radioimmunoassay) occurred in 291/311 (93.6%) and 299/310 (96.5%) of recipients of 3 doses of the Korean and U.S. vaccines, respectively (P = 0.10). There were no meaningful differences in vaccine adverse effects, and 92.6% of recipients of either vaccine completed 3 doses.(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Students, Health Occupations , Vaccination/economics , Viral Hepatitis Vaccines/administration & dosage , Adolescent , Adult , Costs and Cost Analysis , Hepatitis B Vaccines , Humans , Korea , Male , Middle Aged , Surveys and Questionnaires , United States , Vaccination/statistics & numerical data , Vaccines, Synthetic/administration & dosage , Vaccines, Synthetic/adverse effects , Vaccines, Synthetic/immunology , Viral Hepatitis Vaccines/adverse effects , Viral Hepatitis Vaccines/immunology
20.
Can J Public Health ; 83(1): 19-23, 1992.
Article in English | MEDLINE | ID: mdl-1571877

ABSTRACT

Public health and hospital nurses have widespread contact with smokers; an effective smoking cessation program administered by nurses has tremendous potential. This study evaluated: 1) the effectiveness of the self-help cessation program, "Time to Quit"/"Moi aussi, j'écrase" (TTQ), provided on a one-to-one basis; and 2) a smoking cessation training program for baccalaureate nursing students. Nursing students recruited 307 smokers who were randomly assigned to receive one of two interventions. Control smokers received a list of community smoking cessation resources and experimental subjects received this list plus TTQ. Smoking self-reports and cotinine levels were obtained at baseline, six weeks and nine months. More smokers receiving TTQ had reduced at six weeks post-intervention, while there were no differences in quit or reduction rates at the nine-month follow-up. Students were positive about learning the techniques and their knowledge scores were significantly higher than those of non-participating students.


Subject(s)
Smoking Cessation/methods , Students, Nursing , Adult , Aged , Cotinine/analysis , Education, Nursing, Baccalaureate , Female , Humans , Male , Middle Aged , Saliva/chemistry , Self-Assessment , Surveys and Questionnaires , Time Factors
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