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Jumper Westfall MBE, Dong F, Becker-Haimes EM, Miao L, Conroy C, Sarpal D, Abegunde C, Bennett M, Kohler CG, Calkins ME. COVID-19 Impacts on Pennsylvania Coordinated Specialty Care for Early Psychosis Participants. Disaster Med Public Health Prep 2023; 17:e488. [PMID: 37697955 DOI: 10.1017/dmp.2023.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
OBJECTIVES The coronavirus disease (COVID-19) pandemic produced swift, extensive changes in daily life, including for first-episode psychosis (FEP) clients. This study examined pandemic-related psychosocial impacts to clients while engaged in Coordinated Specialty Care (CSC). We also examined FEP client vaccination rates, as vaccinations can reduce hospitalizations/deaths, and related worries. METHODS Thirty-one clients (45% female; ages 13-39; 26% black, 61% white) from Pennsylvania (PA) CSC outpatient programs completed an online survey evaluating exposure to COVID-19, associated worries, coping, and safety strategies. Descriptive statistics characterized responses and demographic group differences. Additional program evaluation data informed vaccination rates for PA FEP clients. RESULTS Participants reported substantial pandemic-related impacts to daily life. Many clients reported improved safety measures to protect themselves/others from COVID-19. Clients largely denied substantial worries about infection for themselves, reporting greater concern for loved ones. Multiple coping strategies were endorsed, which, with few exceptions, did not differ among demographic groups. FEP clients had a low reported rate of vaccination (28.6%) as of September 2021. CONCLUSIONS Observed prolonged pandemic effects may alter FEP client progress in CSC. Stakeholders should be prepared to adjust FEP treatment accordingly in the event of a similar disaster. Concentrated vaccination efforts may be necessary for this population.
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Affiliation(s)
- Megan B E Jumper Westfall
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Fanghong Dong
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Emily M Becker-Haimes
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lucy Miao
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Catherine Conroy
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Deepak Sarpal
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Courtney Abegunde
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Melanie Bennett
- Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Christian G Kohler
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Monica E Calkins
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Dong F, Jumper MBE, Becker-Haimes EM, Vatza C, Miao L, Conroy C, Bennett M, Sarpal DK, Abegunde C, Kohler CG, Calkins ME. Tele-mental Health Transitions for Pennsylvania Coordinated Specialty Care Programs for Early Psychosis During the COVID-19 Pandemic. Psychiatr Q 2023:10.1007/s11126-023-10015-0. [PMID: 36820952 PMCID: PMC9947877 DOI: 10.1007/s11126-023-10015-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 02/24/2023]
Abstract
This study examined provider and client perspectives of tele-mental health (TMH) in early psychosis care during the COVID-19 pandemic. To achieve this goal, thirty-three mental health providers and 31 clients from Pennsylvania Coordinated Specialty Care (CSC) programs completed web-based surveys assessing TMH usage, experiences, and perceptions between May and September 2020. Three additional TMH-related questions were asked two years later of PA CSC Program Directors between Feb and March 2022. Descriptive statistics characterized responses. Open-ended items were coded and grouped into themes for qualitative synthesis. As early as mid-2020, participants reported extensive use of TMH technologies, including telephone and video visits. Although most providers and clients preferred in-person care to TMH, most clients still found TMH to be comparable to or better than in-person care; 94% of clients indicated interest in future TMH services. Providers also noted more successes than challenges with TMH. Nine themes emerged regarding provider-perceived client characteristics that could benefit from TMH and were grouped into two categories: client-level (access to technology, comfort with technology, transportation, young age, symptom severity, functioning level, motivation for treatment adherence) and interpersonal-level (external support systems and engagement with program prior to the pandemic) characteristics. Two years later, program directors reported continued perceived advantages of TMH in CSCs, although some barriers persisted. Despite the unexpected shift to TMH in early psychosis programs during the COVID-19 pandemic, findings indicated a relatively positive transition to TMH and perceived promise of TMH as a sustained part of routine care.
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Affiliation(s)
- Fanghong Dong
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA 19104 USA
| | - Megan B. E. Jumper
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA 19104 USA
| | - Emily M. Becker-Haimes
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA 19104 USA
| | - Crystal Vatza
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA 19104 USA
| | - Lucille(Lucy) Miao
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA 19104 USA
| | - Catherine Conroy
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA 19104 USA
| | - Melanie Bennett
- Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, MD USA
| | - Deepak K. Sarpal
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Courtney Abegunde
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Christian G. Kohler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA 19104 USA
| | - Monica E. Calkins
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA 19104 USA
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Kuhn E, Sayers SL, Babusci C, Conroy C, Erbes CR. Internet-based family training with telephone coaching to promote mental health treatment initiation among veterans with posttraumatic stress disorder: A pilot study. J Trauma Stress 2022. [PMID: 36562921 DOI: 10.1002/jts.22900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/05/2022] [Accepted: 10/27/2022] [Indexed: 12/24/2022]
Abstract
Posttraumatic stress disorder (PTSD) is common among military veterans, yet many affected veterans do not seek treatment. Family members of these veterans often experience compromised well-being and a desire for the veteran to receive mental health care. The Veterans Affairs (VA)-Community Reinforcement and Family Training (VA-CRAFT) for PTSD is an internet-based intervention intended to teach veterans' family members skills to encourage veterans to initiate mental health care. This study assessed the feasibility, acceptability, and potential efficacy of VA-CRAFT with telephone coaching in a sample of 12 spouses and intimate partners of veterans with PTSD. Participants completed the intervention over 12 weeks and were assessed pre- and posttreatment. For feasibility, 75.0% (n = 9) of participants completed the intervention and reported few difficulties and ease of use. Supporting acceptability, all nine completers had mostly favorable impressions of the intervention and perceived it as helpful. Finally, six (50.0%) participants got the PTSD-affected veteran to engage in mental health care; however, aside from potentially increasing treatment talk frequency, outcome expectancy, and self-efficacy, ds = 0.60-1.08, no apparent improvements were observed for any well-being outcomes, ds = 0.01-0.40. Although the findings are promising, given the study limitations, future research is required to evaluate this approach in a full-scale randomized controlled trial.
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Affiliation(s)
- Eric Kuhn
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Steven L Sayers
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christina Babusci
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Catherine Conroy
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Christopher R Erbes
- Center for Chronic Disease Outcomes Research, Minneapolis VA HealthCare System, Minneapolis, Minnesota, USA.,Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Pradhan V, James N, Conroy C. P.45 Retrospective review of perioperative analgesia for caesarean section comparing intrathecal morphine with combined intrathecal morphine and fentanyl. Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Westfall MBE, Kohler CG, Hurford I, Abegunde C, Agosti D, Brinen A, Cadman ML, Conroy C, Ered A, Fooks A, Franco O, Huque ZM, Namowicz D, O'Connor S, Oross M, Payne E, Sarpal DK, Schmidt LR, Swigart A, Wenzel RM, Calkins ME. Pennsylvania coordinated specialty care programs for first-episode psychosis: 6- and 12-month outcomes. Early Interv Psychiatry 2021; 15:1395-1408. [PMID: 33283472 DOI: 10.1111/eip.13084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/16/2020] [Accepted: 11/14/2020] [Indexed: 01/21/2023]
Abstract
AIM Pennsylvania (PA) first-episode psychosis (FEP) program evaluation is a statewide initiative, supported by the PA Office of Mental Health and Substance Abuse Services (PA-OMHSAS) and administered by PA Early Intervention Center/Heads Up, which evaluates fidelity and outcomes of PA Coordinated Specialty Care (CSC) programs. Programs participate in standard computerized measures of CSC outcomes using centralized informatics. The aims of the current report are to describe implementation of this core battery for program evaluation in PA and to present 6- and 12-month outcomes. METHODS Participants (n = 697) from nine PA CSC programs completed the core battery at admission. The battery was re-administered at 6- and 12-month follow-up, and data were analysed for individuals (n = 230) who had completed 12-months of treatment. Domains assessed via clinician report and/or self-report included symptoms, role and social functioning, self-perceived recovery and service utilization. RESULTS PA FEP CSC participants showed improvement over time in several domains, including decreased symptoms, higher role and social functioning, decreased hospitalizations, and improved self-perception of recovery, quality of life, and services satisfaction. Trends towards improvements were observed for participant happiness, hopelessness, and school-enrolment. Nearly all improvements were observed at 6-month follow-up, with earlier gains maintained at 12-months. CONCLUSIONS PA FEP CSC programs demonstrate the ability to assess and improve critical outcomes of coordinated specialty care in PA. Improved outcomes by 12 months in treatment provides evidence of an effective treatment model and supports the continuation of these programs in pursuit of our goal of reducing schizophrenia disease burden on individuals and society.
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Affiliation(s)
- Megan B E Westfall
- Pennsylvania Early Intervention Center (PEIC)/Heads Up, Psychosis and Neurodevelopment Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christian G Kohler
- Pennsylvania Early Intervention Center (PEIC)/Heads Up, Psychosis and Neurodevelopment Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Psychosis Evaluation and Recovery Center (PERC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Irene Hurford
- Pennsylvania Early Intervention Center (PEIC)/Heads Up, Psychosis and Neurodevelopment Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Courtney Abegunde
- STEP Clinic, UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
| | - Dominick Agosti
- Connect 2 Empower, CMSU Behavioral Health Services, Danville, Pennsylvania, USA
| | - Aaron Brinen
- Department of Psychiatry, Drexel College of Medicine, Philadelphia, Pennsylvania, USA
| | - Mary Lyn Cadman
- Connect 2 Empower, CMSU Behavioral Health Services, Danville, Pennsylvania, USA
| | - Catherine Conroy
- Pennsylvania Early Intervention Center (PEIC)/Heads Up, Psychosis and Neurodevelopment Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Arielle Ered
- Psychosis Evaluation and Recovery Center (PERC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
| | - Amanda Fooks
- CAPSTONE, Pennsylvania Psychiatric Institute, Harrisburg, Pennsylvania, USA
| | - Olivia Franco
- Psychosis Evaluation and Recovery Center (PERC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zeeshan M Huque
- Psychosis Evaluation and Recovery Center (PERC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Denise Namowicz
- Helping to Overcome Psychosis Early (HOPE), Children's Service Center, Wilks-Barre, Pennsylvania, USA
| | - Seamus O'Connor
- On My Way, Child and Family Focus, Inc., Broomall, Pennsylvania, USA
| | - Molly Oross
- ENGAGE, Wesley Family Services, Pittsburgh, Pennsylvania, USA
| | - Elisa Payne
- Psychosis Evaluation and Recovery Center (PERC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Deepak K Sarpal
- STEP Clinic, UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
| | - Lyndsay R Schmidt
- Psychosis Evaluation and Recovery Center (PERC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alison Swigart
- CAPSTONE, Pennsylvania Psychiatric Institute, Harrisburg, Pennsylvania, USA
| | | | - Monica E Calkins
- Pennsylvania Early Intervention Center (PEIC)/Heads Up, Psychosis and Neurodevelopment Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Psychosis Evaluation and Recovery Center (PERC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Dolan C, Glynn R, Griffin S, Conroy C, Loftus C, Wiehe PC, Healy ML, Lawlor B. Brain complications of diabetes mellitus: a cross-sectional study of awareness among individuals with diabetes and the general population in Ireland. Diabet Med 2018; 35:871-879. [PMID: 29653018 DOI: 10.1111/dme.13639] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2018] [Indexed: 12/17/2022]
Abstract
AIMS To identify awareness of potential brain complications of diabetes among individuals with diabetes and the public. METHODS For this observational, cross-sectional survey study, we recruited consecutive adult attendees of a specialist diabetes clinic and two primary care practices. Primary care attendees represented members of the general population of Ireland. An interviewer-administered questionnaire was used to gather data on respondents' awareness of brain complications of diabetes and modifiable risk factors for dementia. Multivariable logistic regression was undertaken to identify variables independently associated with awareness. RESULTS Respondents included a total of 502 adults: 250 in the diabetes group (37% women, mean age 63 ± 14 years, 88% with Type 2 diabetes) and 252 in the general population group (51% women, mean age 47 ± 17 years, 7% with Type 2 diabetes). The diabetes group had significantly greater awareness of diabetes complications, except for depression, compared with the general population group. In the group as a whole, respondent awareness of dementia (35%) and memory problems (47%) as potential complications of diabetes was poor compared with awareness of kidney (84%) and eye damage (84%). Respondents were 1.5 times more likely to identify that individuals can modify their risk of developing Type 2 diabetes than their risk of dementia. CONCLUSIONS This study shows that there is poor awareness of brain complications of diabetes among individuals with diabetes and the general population in Ireland. The results suggest a need for expansion of public awareness campaigns and diabetes education programmes to promote awareness of the brain complications of diabetes and of the modifiable risk factors for dementia, as part of a life-course approach to dementia prevention.
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Affiliation(s)
- C Dolan
- Department of Psychiatry, University of Dublin Trinity College, Dublin, Ireland
| | - R Glynn
- Health Service Executive, Public Health and Epidemiology, Dublin, Ireland
| | - S Griffin
- Department of Psychiatry, University of Dublin Trinity College, Dublin, Ireland
| | - C Conroy
- Department of Endocrinology, St James' Hospital, Dublin, Ireland
| | - C Loftus
- Loftus Medical Centre, Primary Care Boyle, Roscommon, Ireland
| | - P C Wiehe
- Sundrive Medical Centre, Primary Care, Dublin, Ireland
| | - M L Healy
- Department of Endocrinology, St James' Hospital, Dublin, Ireland
| | - B Lawlor
- Department of Psychiatry, University of Dublin Trinity College, Dublin, Ireland
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Conroy C, Clarke PJ. Reality Orientation. Br J Occup Ther 2016. [DOI: 10.1177/030802267704001011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Soudi L, Conroy C, Vazquez O. Detection of malaria parasitemia for hotspot identification: employment
of loop-mediated isothermal amplification (LAMP) in remote clinics in
Kenya. Ann Glob Health 2014. [DOI: 10.1016/j.aogh.2014.08.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Gao K, Kemp DE, Conroy C, Ganocy SJ, Findling RL, Calabrese JR. Comorbid anxiety and substance use disorders associated with a lower use of mood stabilisers in patients with rapid cycling bipolar disorder: a descriptive analysis of the cross-sectional data of 566 patients. Int J Clin Pract 2010; 64:336-44. [PMID: 20456174 PMCID: PMC3457056 DOI: 10.1111/j.1742-1241.2009.02284.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To study mood stabiliser treatment in patients with bipolar disorder with or without anxiety disorders (ADs) and/or substance use disorders (SUDs). METHODS Extensive clinical interview and Mini-International Neuropsychiatric Interview were used to ascertain DSM-IV diagnoses of rapid cycling bipolar I (RCBDI) or II (RCBDII), SUDs and ADs. Previous treatment statuses with a mood stabiliser after the first onset of mania/hypomania (unmedicated, mismedicated and correctly medicated) were retrospectively determined in patients enrolled into four similar clinical trials. T-test and chi-square/Fisher's exact were used wherever appropriate. RESULTS Of 566 patients (RCBDI n = 320, RCBDII n = 246), 46% had any lifetime AD, 67% had any lifetime SUD and 40% had any recent SUD. Overall, 12% of patients were unmedicated, 37% were mismedicated at the onset of first mania/hypomania and 51% were correctly medicated. Presence of lifetime ADs and recent SUDs was associated with fewer mood stabiliser treatments. Patients with RCBDI were more likely correctly medicated than those with RCBDII (OR = 3.64) regardless of the presence (OR = 2.6) or absence (OR = 4.2) of ADs, or the presence (OR = 2.8) or absence (OR = 3.13) of recent SUDs. Presence of lifetime ADs and recent SUDs increased the risk for mismedicated in RCBDI with odds ratios of 1.8 and 1.9, respectively, but not in RCBDII. CONCLUSION In this multi-morbid cohort of patients with RCBD, 51% of patients (64% of RCBDI and 33% with RCDBII) were correctly medicated with a mood stabiliser after the onset of first mania/hypomania. The presence of ADs and SUDs was associated with an increased risk of mismedicated in patients with RCBDI, but not with RCBDII.
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Affiliation(s)
- K Gao
- Department of Psychiatry, Mood & Anxiety Clinic at Mood Disorders Program, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA.
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Abstract
AIM To describe the uptake of breast feeding in mothers with either Type 2 diabetes or gestational diabetes (GDM) in a hospital serving a multiethnic community in South Auckland, New Zealand. RESEARCH DESIGN AND METHODS A retrospective study of all women attending the Diabetes in Pregnancy clinic over a 4-year period was undertaken: 30 women had Type 2 diabetes and 373 GDM. RESULTS Compared with mothers with GDM, mothers with Type 2 diabetes were less likely to breast feed in any way as the first feed (41.4% vs. 68.0%, P = 0.011) or at discharge (69.0% vs. 84.0%, P = 0.039). In the combined group, there were no differences in uptake of breast feeding by ethnicity, age, parity, body mass index, smoking or antenatal glycaemia, use of insulin or presence of hypertension. Breast feeding on discharge was associated with a higher APGAR score, breast feeding as the first feed (78.2% vs. 19.4%, P < 0.001) and lower rates of delivery by Caesarean section (17.0% vs. 31.8%, P = 0.006). Logistic regression showed breast feeding as the first feed, the major determinant for breast feeding on discharge. CONCLUSIONS Factors delaying breast feeding as the first feed are the major determinant of breast feeding on discharge. Strategies to increase breast feeding as the first feed among women with Type 2 diabetes, and those having a Caesarean section, may be useful in increasing the uptake of breast feeding in the longer term.
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Affiliation(s)
- D Simmons
- Waikato Clinical School, University of Auckland, Hamilton, New Zealand.
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Abstract
OBJECTIVE To describe the use of insulin pump therapy in women with gestational diabetes mellitus (GDM) or type 2 diabetes in pregnancy and persistent hyperglycemia despite multiple injections of subcutaneous insulin. RESEARCH DESIGN AND METHODS As part of a service audit, deliveries to women with diabetes at a single South Auckland hospital were reviewed from 1991 through 1994. Glycemic control was estimated by the mean of self-recorded and laboratory postprandial glucose concentrations. In a nested case-control study, pregnancies complicated by GDM/type 2 diabetes with use of an insulin pump were compared with those without insulin pump therapy and peak insulin requirements of 100-199 units/ day, matched for ethnicity and type of diabetes. RESULTS A total of 30 of 251 Polynesian, European, and South Asian women with singleton pregnancies complicated by insulin-requiring GDM/type 2 diabetes used an insulin pump. An additional two women with high insulin requirements discontinued pump therapy. None of the women with GDM/type 2 diabetes experienced severe hypoglycemia, whereas 79% of the women had improved glycemic control within 1-4 weeks. Mothers using a pump had greater insulin requirements (median maximum 246 vs. 130 units per day) and greater weight gain (10.6 vs. 5.0 kg). Their babies were more likely to be admitted to the Special Care Baby Unit but were neither significantly heavier nor experienced greater hypoglycemia than control subjects. CONCLUSIONS Insulin pump therapy seems to be safe and effective for maintaining glycemic control in pregnancies complicated by GDM/type 2 diabetes and requiring large doses of insulin.
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Affiliation(s)
- D Simmons
- Department of Rural Health, University of Melbourne, Shepparton, Victoria, Australia.
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Spaite DW, Conroy C, Karriker KJ, Seng M, Battaglia N. Improving emergency medical services for children with special health care needs: does training make a difference? Am J Emerg Med 2001; 19:474-8. [PMID: 11593465 DOI: 10.1053/ajem.2001.27146] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
This study evaluated the impact of a paramedic training program on emergency medical services (EMS) responses for children with special health care needs. EMS responses for children with a congenital or acquired condition or a chronic physical or mental illness, were reviewed. Responses, related to the child's special health care need, involving paramedics who had completed our training program were compared with responses with paramedics not participating in the training. There was significantly more advanced life support treatment for responses with paramedics completing the training program compared with other responses. However, there was no significant difference in transport to a hospital or in-hospital admission between these 2 groups. This finding suggests that existing EMS protocols may play a more important role in emergency treatment and transport of children with special health care needs than specialized training of already certified paramedics.
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Affiliation(s)
- D W Spaite
- College of Medicine, University of Arizona, Tucson, AZ 85724, USA
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Conroy C. Developing visual aids to enhance presentations. Oncol Nurs Forum 2001; 28:1093-4. [PMID: 11517842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- C Conroy
- St. Alexius Medical Center, Hoffman Estates, IL, USA
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Nicholls M, Horler K, Campbell D, Conroy C, Cattell R. Medicines. Peace in a POD (patients' own drug). Health Serv J 2001; 111:35. [PMID: 11464781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
- M Nicholls
- Pharmacy Department, Bristol Royal Infirmary
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Spaite DW, Karriker KJ, Conroy C, Seng M, Battaglia N, Salik RM. Emergency medical services assessment and treatment of children with special health care needs before and after specialized paramedic training. Prehosp Disaster Med 2001; 16:96-101. [PMID: 11513288 DOI: 10.1017/s1049023x00025760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION This study evaluates whether a continuing education program for paramedics, focusing on Children with Special Health Care Needs, improved paramedics' assessment and management. METHODS Emergency Medical Services responses for children, 21 years of age or younger, with a congenital or acquired condition or a chronic physical or mental illness, were identified. The responses before and after the specialized education program were reviewed by a multidisciplinary team to evaluate assessment and management of the children. Interreviewer agreement between the nurses on the team and between the physicians on the team was assessed. We also evaluated whether there was an improvement in assessment and care by paramedics completing our education program. RESULTS Significant improvement was seen in appropriate assessment and overall care by paramedics who completed our specialized education program. Reviewers also noted an appropriate rating for the initial assessment category more often for responses involving paramedics who had the training. Agreement on whether assessment and treatment was appropriate for all five reviewers varied considerably, ranging from 32% to 93%. Overall there was a high percentage of agreement (>70%) between the nurses and between the physicians on most items. However, kappa statistics did not generally reflect good agreement except for most of the focused assessment items and some treatment and procedure items. CONCLUSION Most of the documentation on the EMS records indicated appropriate assessment and treatment during all responses for Children with Special Health Care Needs. Nevertheless, the results indicate that paramedics may improve their assessment and management of these children after specialized continuing education.
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Affiliation(s)
- D W Spaite
- Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona, Tucson 85721-0468, USA
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16
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Simmons D, Conroy C, Scott D. Impact of a diabetes midwifery educator on the diabetes in pregnancy service at Middlemore Hospital. ACTA ACUST UNITED AC 2001. [DOI: 10.1002/pdi.164] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
AIMS To describe the incidence and risk factors for neonatal hypoglycaemia among the offspring of women with gestational diabetes mellitus (GDM) in South Auckland, New Zealand METHODS A retrospective audit was undertaken of singleton pregnancies delivered between 1991 and 1994. Data were obtained for 373 women and their deliveries (57 European, 76 Maori, 198 Pacific Islands, 42 other). RESULTS Pacific Islands women were most likely to have large babies with neonatal hypoglycaemia in spite of a high use of insulin. Postnatally Maori and Pacific Islands women had a high incidence of Type 2 diabetes mellitus (21.4, 21.7 vs. 4.3% Europeans, 12.0% others, P =0.035). Babies experiencing hypoglycaemia were more likely to have a mother with past GDM (51.2 vs. 27.2%, P = 0.01) and greater hyperglycaemia (at diagnosis fasting 6.8 +/- 1.7 vs. 5.7 +/- 1.1 mmol/l, P < 0.001; finger-prick glucose 5.7 +/- 1.0 vs. 5.2 +/- 0.8 mmol/l, P < 0.001). Macrosomia, Caesarian section and special care baby unit admission were more common in pregnancies complicated by neonatal hypoglycaemia. CONCLUSIONS Maternal hyperglycaemia was a major contributing factor to neonatal hypoglycaemia in this population. Undiagnosed Type 2 diabetes was common among Maori and Pacific Islands women, confirming the need for earlier detection and treatment.
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Affiliation(s)
- D Simmons
- Department of Rural Health, University of Melbourne, Shepparton, Victoria, Australia.
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18
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Abstract
The Haddon matrix is a research tool used by injury epidemiologists. Although this matrix has typically been used only in epidemiologic studies, it may serve as a framework to investigate the circumstances of traumatic deaths. This matrix consists of three rows representing time phases (before the injury incident, during the incident, and after the incident) and four columns representing the energy agent, characteristics of the deceased person, the environment, and the vehicle or vector resulting in the abnormal energy exchange, which are considered in the context of the three time phases. The authors present four cases illustrating how this epidemiologic tool can be useful during death investigations. Although the objectives for epidemiologic studies and medicolegal death investigations differ, this approach can be used to describe the circumstances surrounding an injury-related death.
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Affiliation(s)
- C Conroy
- Arizona Emergency Medicine Research Center, Tucson 85724, USA
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Spaite DW, Karriker KJ, Seng M, Conroy C, Battaglia N, Tibbitts M, Meislin HW, Salik RM, Valenzuela TD. Increasing paramedics' comfort and knowledge about children with special health care needs. Am J Emerg Med 2000; 18:747-52. [PMID: 11103722 DOI: 10.1053/ajem.2000.16300] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
This study evaluated a continuing education program for paramedics about children with special health care needs (CSHCN). Pretraining, posttraining, and follow-up surveys containing two scales (comfort with CSHCN management skills and comfort with Pediatric Advanced Life Support [PALS] skills) were administered. Objective measures of knowledge were obtained from pre- and posttraining tests. Differences in average scores were assessed using t-tests. Response rates for paramedics completing the program ranged from 94% for the posttraining survey, 81% for the initial comfort survey, 56% for the knowledge pretest, and 56% for the follow-up survey. PALS comfort scores were significantly higher than CSHCN comfort scores both before and after training, both P < .01. Posttraining surveys showed an increase in CSHCN comfort, P < .01. The follow-up surveys showed a significant decline in CSHCN comfort, P = .05. Scores on the tests showed a similar pattern, with a significant increase in knowledge from pre- to posttraining (P = .02) and a significant decrease in knowledge from posttraining to follow-up (P < .01). Comfort was significantly higher for standard pediatric skills than for specialized management skills. Completion of the self-study program was associated with an increase in comfort and knowledge, but there was some decay over time.
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Affiliation(s)
- D W Spaite
- Arizona Emergency Medicine Research Center, College of Medicine, The University of Arizona, Tucson 85724, USA.
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20
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Campbell D, Cattell R, Conroy C. Pharmacy. Waste not, want not. Health Serv J 2000; 110:31. [PMID: 11184526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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21
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Abstract
Early hominid brain morphology is reassessed from endocasts of Australopithecus africanus and three species of Paranthropus, and new endocast reconstructions and cranial capacities are reported for four key specimens from the Paranthropus clade. The brain morphology of Australopithecus africanus appears more human like than that of Paranthropus in terms of overall frontal and temporal lobe shape. These new data do not support the proposal that increased encephalization is a shared feature between Paranthropus and early Homo. Our findings are consistent with the hypothesis that Australopithecus africanus could have been ancestral to Homo, and have implications for assessing the tempo and mode of early hominid neurological and cognitive evolution.
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Affiliation(s)
- D Falk
- Department of Anthropology, University at Albany, SUNY, Albany, NY 12222, USA.
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22
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Spaite DW, Karriker KJ, Seng M, Conroy C, Battaglia N, Tibbitts M, Salik RM. Training paramedics: emergency care for children with special health care needs. PREHOSP EMERG CARE 2000; 4:178-85. [PMID: 10782609 DOI: 10.1080/10903120090941470] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To enhance knowledge and comfort related to the emergency care of children with special health care needs (CSHCN) through an innovative continuing education program for paramedics. METHODS A self-study program presenting in-depth information about common problems that affect the assessment and management of a child's airway, breathing, circulation, disability, and environment (ABCDEs), regardless of the child's diagnosis, was developed. This program used a manual, a video, practice mannequins, and skills evaluations to teach skills to paramedics employed at a municipal fire department. RESULTS Pre- and posttraining surveys found that the paramedics were significantly more comfortable with the assessment and management of CSHCN after the completion of the self-study program, with a pretraining average of 2.83 and posttraining average of 4.20 on a five-point Likert-type scale, t(37) = 12.87, p < 0.001. A skills evaluation showed that skills performance varied widely across 21 skills, ranging from skills mastery to low skills knowledge. On the posttraining survey, between 74% and 94% of the paramedics rated each topic (tracheostomies, indwelling central venous catheters, cerebrospinal fluid shunts, gastrostomies, child abuse, and latex allergy) as applicable to their practices as paramedics. CONCLUSION Given the growing population of CSHCN, it is important to provide specialized education to increase an EMS provider's preparedness to respond to emergency situations involving children with special health care needs.
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Affiliation(s)
- D W Spaite
- Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona, Tucson, USA
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23
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Abstract
Unfortunately, lipid-lowering drug therapy remains underutilized in clinical practice, and few secondary prevention patients achieve the low-density lipoprotein (LDL) cholesterol level (< or = 100 mg/dl) recommended by the National Cholesterol Education Program. To improve patient management, a telephone-based computerized system primarily managed by dietitians was implemented in one of our cardiology clinics. Lipid results from all lipid and cardiology referrals and patients admitted to the cardiology service at 1 hospital are managed through this system. Patients are contacted via computer-generated postcards and the dietitians every 3 to 6 months. At baseline (September 1, 1994, through August 31, 1995; n = 1,969), 34% and 66% had LDL cholesterol < or = 100 and < or = 130 mg/dl, respectively. By September 1, 1997, to August 31, 1998 (n = 2,827), the proportion of patients with LDL cholesterol < or = 100 mg/dl had increased to 61%, and 89% had LDL cholesterol < or = 130 mg/dl. Statin use increased from 47% to 85% of patients. By 1997 to 1998, 74% and 40% of patients received statin doses that would, on average, produce a 34% and 41% reduction in LDL cholesterol, respectively. Whether a patient had LDL cholesterol < or = 100 mg/dl was not predicted by patient characteristics, drugs given, or by medication insurance coverage.
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Affiliation(s)
- J G Robinson
- Preventive Medicine & Research, Iowa Heart Center, Des Moines 50314, USA.
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Spaite DW, Conroy C, Tibbitts M, Karriker KJ, Seng M, Battaglia N, Criss EA, Valenzuela TD, Meislin HW. Use of emergency medical services by children with special health care needs. PREHOSP EMERG CARE 2000; 4:19-23. [PMID: 10634277 DOI: 10.1080/10903120090941579] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study describes emergency medical services (EMS) responses for children with special health care needs (CSHCN) in an urban area over a one-year period. METHODS A prospective surveillance system was established to identify EMS responses for children, 21 years of age or younger, with a congenital or acquired condition or a chronic physical or mental illness. Responses related to the special health care needs of the child were compared with unrelated responses. RESULTS During a one-year period, 924 responses were identified. Fewer than half of the responses were related to the child's special health care need. Younger children were significantly more likely to have a response related to their special needs than older children. Among related responses, seizure disorder was the most common diagnosis, while asthma was more common for unrelated responses. Almost 58% of the responses resulted in transport of the child to a hospital. CONCLUSIONS Emergency medical services responses related to a child's special health care needs differ from unrelated responses. The most common special health care needs of children did not require treatment beyond the prehospital care provider's usual standard of care. These results are relevant for communities providing EMS services for CSHCN.
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Affiliation(s)
- D W Spaite
- Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona, Tucson, USA
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25
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Gibly R, Williams M, Walter FG, McNally J, Conroy C, Berg RA. Continuous intravenous midazolam infusion for Centruroides exilicauda scorpion envenomation. Ann Emerg Med 1999; 34:620-5. [PMID: 10533010 DOI: 10.1016/s0196-0644(99)70164-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE We sought to describe the effects of continuous intravenous midazolam infusion as therapy for severe bark scorpion (Centruroides exilicauda) envenomation. METHODS A retrospective chart review from July 1, 1993, through January 1, 1998, identified all patients treated at a university hospital with International Classification of Diseases, Ninth Revision, codes 989.5 (toxic effect of venom) or E905.2 (scorpion sting causing poisoning). By using standardized collection forms, data were extracted from the medical record of every patient who had a grade III or IV envenomation and was treated with a continuous intravenous midazolam infusion. RESULTS Our search identified 104 patients; 34 had grade III or IV envenomation. Of these, 33 were treated in the ICU with continuous intravenous midazolam infusion. Median patient age was 4 years (range, 1 to 68 years). Midazolam dosage was adjusted to induce a light sleep state to control agitation and involuntary motor activity. The median amount of midazolam resulting in the first recorded decrease in agitation and involuntary motor activity was 0.30 mg/kg (range, 0.03 to 1.76 mg/kg). This first evidence of clinical improvement was recorded as 1.00 hour (median), with a range of 0.00 to 3.75 hours. The initial midazolam infusion rate was 0.10 mg x kg(-1) x h(-1) (median), with a range of 0.01 to 0.31 mg x kg(-1) x h(-1). The maximal midazolam infusion rate was 0.30 mg x kg(-1) x h(-1) (median), with a range of 0.06 to 1.29 mg x kg(-1) x h(-1). The median time until the maximal midazolam infusion rate was 2.5 hours (range, 0.00 to 8.50 hours). The median duration of infusion was 9. 50 hours (range, 4.25 to 20.50 hours). The median length of stay in the ICU was 15.17 hours (range, 6.0 to 28.0 hours), and 85% of patients were discharged directly home. All patients had resolution of abnormal motor activity and agitation during their midazolam infusion. Transient hypoxemia without evidence of end-organ dysfunction was documented in 4 patients during midazolam therapy. CONCLUSION A continuous intravenous midazolam infusion can be a safe, effective, and readily available treatment option for patients with grade III or IV C exilicauda envenomation.
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Affiliation(s)
- R Gibly
- Emergency Room Associates, Carondelet St. Joseph's Hospital, Tucson, AZ, USA
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26
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Spaite DW, Bartholomeaux F, Guisto J, Lindberg E, Hull B, Eyherabide A, Lanyon S, Criss EA, Valenzuela TD, Conroy C. Rapid process redesign in a university-based emergency department: Decreasing waiting time intervals and improving patient satisfaction. Ann Emerg Med 1999. [DOI: 10.1016/s0196-0644(99)80155-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
STUDY OBJECTIVE There is a time continuum from emergency medical services (EMS) dispatch, response, scene, transport, and arrival at the hospital. Previous research has documented favorable patient outcome with short response intervals; however, these studies revealed the documentation of EMS time intervals is not always consistent. This study evaluates how agencies estimate these times and factors that may affect the length of response intervals. METHODS The study used a mail questionnaire to assess factors related to response intervals and to determine how agencies define and record response intervals. All ground-based EMS agencies in a southwestern state were invited to participate in the survey. Univariate and stratified data analyses compared definitions of response intervals. RESULTS Agencies varied as to how they defined the start and end of the response. Fifty-six percent stated that their response started when the responding unit was notified of the call. However, almost 23% defined response interval as starting when dispatch received the call, and 11% defined it as starting with the initial 911 call. A factor that affected response intervals was routing of the 911 call. Less than 6% of agencies had only 1-call routing. CONCLUSION Agencies use different time points as the start and end of their response interval, which makes comparison of results directly related to response intervals across agencies or regions difficult. To maintain an appropriate standard of prehospital emergency medical care throughout the state, the use of consistent standard terminology defining response intervals will help reach that goal.
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Affiliation(s)
- H W Meislin
- Arizona Emergency Medicine Research Center and the Arizona Health Sciences Center, Tucson, AZ, USA.
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28
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Abstract
BACKGROUND Almost half of all trauma deaths occur at the scene. It is important to determine if these deaths can be prevented. METHODS Penetrating or blunt force trauma deaths were identified through the Office of the Medical Examiner during a 2-year period. Data were also obtained through review of these records. RESULTS There were 312 deaths at the scene that received no medical care. Almost 60% were firearm-related. About 80% of the victims were men, and 55% of these deaths occurred in people between 20 and 49 years old. Suicide accounted for nearly half of these deaths. Eighty percent of these injured people had Abbreviated Injury Scale scores of 5 or 6. CONCLUSION Almost 60% of deaths at the scene occurred at the same time as injury and reflect severe injury to vital regions of the body. These findings suggest that primary prevention of the initial event causing injury may be more important than definitive prehospital emergency medical care to prevent these deaths.
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Affiliation(s)
- H Meislin
- Arizona Emergency Medicine Research Center, Arizona Health Sciences Center, Tucson 85724, USA
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29
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Abstract
OBJECTIVE The need for valid and reliable emergency medical services (EMS) data has long been recognized. EMS data are useful for monitoring resources and operations, documenting patient care and outcome, and evaluating injury prevention strategies. The goal of this project was to develop a computerized data set with the capability to generate a patient care record (PCR) to overcome some of the current EMS data limitations. METHODS The authors discuss developing an electronic PCR and analysis data set containing 233 variables. Data are collected for the following: incident, response, scene, patient, history, primary survey (including vital signs), physical examination, physiologic scores, diagnostics, plan (medications and procedures), assessment, and reevaluation. Software on a portable computer installed in an EMS response unit utilizes a graphical user interface for data collection by prehospital emergency care providers. A data set stores codes corresponding to user's selections. This data set supports data storage and analysis. The electronic PCR and data set can be useful to EMS agencies for collecting, storing, reporting, and analyzing information. RESULTS Variables are categorized into 12 main categories to categorize the variables and to drive data collection. The system provides the user with the ability to print out a record (using a portable printer installed in an ambulance) and analyze data stored in the data set. CONCLUSION This computerized approach overcomes many limitations inherent with using paper-based systems for research. Linked with emergency department, hospital discharge, and mortality data, EMS data can be used in systems analyses related to patient outcome.
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Affiliation(s)
- H W Meislin
- Arizona Emergency Medicine Research Center, Arizona Health Sciences Center, Tucson 85724-5057, USA.
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30
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Johnston GD, Wilson R, McDermott BJ, Conroy C. A low dose atenolol/bendrofluazide combination in patients with mild to moderate hypertension. J Hum Hypertens 1997; 11:759-60. [PMID: 9416987 DOI: 10.1038/sj.jhh.1000561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Meislin H, Criss EA, Judkins D, Berger R, Conroy C, Parks B, Spaite DW, Valenzuela TD. Fatal trauma: the modal distribution of time to death is a function of patient demographics and regional resources. J Trauma 1997; 43:433-40. [PMID: 9314304 DOI: 10.1097/00005373-199709000-00008] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Unlike previous studies in an urban environment, this study examines traumatic death in a geographically diverse county in the southwestern United States. METHODS All deaths from blunt and penetrating trauma between November 15, 1991, and November 14, 1993, were included. As many as 150 variables were collected on each patient, including time of injury and time of death. Initial identification of cases was through manual review of death records. Information was supplemented by review of hospital records, case reports, and prehospital encounter forms. RESULTS A total of 710 traumatic deaths were analyzed. Approximately half of the victims, 52%, were pronounced dead at the scene. Of the 48% who were hospitalized, the most frequent mechanism of injury was a fall. Neurologic dysfunction was the most common cause of death. Two distinct peaks of time were found on analysis: 23% of patients died within the first 60 minutes, and 35% of patients died at 24 to 48 hours after injury. CONCLUSIONS Although there appears to continue to be a trimodal distribution of trauma deaths in urban environments, we found the distribution to be bimodal in an environment with a higher ratio of blunt to penetrating trauma.
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Affiliation(s)
- H Meislin
- Arizona Emergency Medicine Research Center, Department of Surgery, College of Medicine, University of Arizona, Tucson 85724-5057, USA
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Abstract
We have conducted a prospective, double blind trial of low level laser therapy (LLLT) in musculoskeletal injuries to assess its efficacy. We assigned patients with a variety of painful skeletal soft tissue conditions to one of two treatment groups, treatment from a functional machine, placebo treatment from an inactive machine. Both machines were identical and both appeared functional. The operative status of each machine was unknown to both the therapist and the patient. The results suggest that LLLT has no significant therapeutic effect and acts primarily as a placebo.
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Affiliation(s)
- D Mulcahy
- Department of Orthopaedics, Adelaide Hospital, Dublin, Ireland
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34
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Simmons D, Scott DJ, Conroy C, Ansell D. Criteria for gestational diabetes: a cautionary tale. N Z Med J 1993; 106:429-30. [PMID: 8414281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The diagnosis of gestational diabetes was developed to predict neonatal outcome (particularly perinatal mortality, macrosomia and hypoglycaemia) and future maternal diabetes. A variety of criteria for this diagnosis have evolved over time, assessed predominantly among European women. We describe a Pacific Islands woman with multiple risk factors for future diabetes yet a borderline 100 g glucose tolerance test result, who delivered a stillborn macrosomic baby weighing 6.7 kg at 38 weeks' gestation. Six weeks postpartum, diabetes was diagnosed by 75 g oral glucose tolerance test. This case highlights the need for caution when interpreting the glucose tolerance test in pregnancy and suggests that closer fetal monitoring and involvement of the diabetes team may be necessary among women with a borderline glucose tolerance test in the presence of additional risk factors for future diabetes (eg obesity, ethnic group).
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Affiliation(s)
- D Simmons
- Department of Medicine, Middlemore Hospital, Auckland
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Conroy C, Russell JC, Crouse WE, Bender TR, Holl JA. Fatal occupational injury related to helicopters in the United States 1980-1985. Aviat Space Environ Med 1992; 63:67-71. [PMID: 1550537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This paper discusses characteristics of occupational traumatic deaths, caused by helicopters, during 1980-1985. Death certificate data are used to describe demographic characteristics and causes of death. Information from National Transportation Safety Board (NTSB) investigations is used to describe pilot experience and environmental circumstances surrounding the incident. During 1980-1985, 374 worker deaths involving helicopters were identified in the National Traumatic Occupational Fatality (NTOF) database. The majority of deaths resulted from trauma to body organs (including the brain). According to NTSB investigations, 59% of crashes in this study were attributed to pilot error, compared to 16.5% from mechanical failure of the helicopter. Thirty percent of deaths were related to military use of helicopters. While death due to occupational exposure to helicopters is not common, some workers (e.g., helicopter pilots) appear to be at especially high risk. This group should be studied further to develop better strategies for their protection.
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Affiliation(s)
- C Conroy
- Division of Safety Research, National Institute for Occupational Safety and Health, Morgantown, WV
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37
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Russell J, Conroy C. Representativeness of deaths identified through the injury-at-work item on the death certificate: implications for surveillance. Am J Public Health 1991; 81:1613-8. [PMID: 1836109 PMCID: PMC1405281 DOI: 10.2105/ajph.81.12.1613] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND This research investigated the accuracy of the injury-at-work item on the death certificate for surveillance of occupational injury deaths in Oklahoma during 1985 and 1986. METHODS Representativeness of occupational injury deaths identified by death certificates was assessed by comparing these deaths with all occupational injury deaths identified through death certificates, workers' compensation reports, medical examiner reports, and OSHA records for categories of occupation, industry, and external causes of death. RESULTS Certain external causes of death (e.g., motor vehicle traffic deaths) and certain occupations (e.g., farming) and industries (agriculture and services) are more often underidentified through death certificates. CONCLUSIONS The findings of this study support Baker's observation that no single data source contains all deaths or all the data elements necessary to describe occupational injury deaths. Data sources may be combined to improve representativeness through more complete case ascertainment.
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Affiliation(s)
- J Russell
- National Institute for Occupational Safety and Health, Division of Safety Research, Morgantown, WVa
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38
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Conroy C, Russell JC. Medical examiner/coroner records: uses and limitations in occupational injury epidemiologic research. J Forensic Sci 1990; 35:932-7. [PMID: 2391482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Epidemiologic research often relies on existing data, collected for nonepidemiologic reasons, to support studies. Data are obtained from hospital records, police reports, labor reports, death certificates, or other sources. Medical examiner/coroner records are, however, not often used in epidemiologic studies. The National Institute for Occupational Safety and Health's Division of Safety Research has begun using these records in its research program on work-related trauma. Because medical examiners and coroners have the legal authority and responsibility to investigate all externally caused deaths, these records can be used in surveillance of these deaths. Another use of these records is to validate cases identified by other case ascertainment methods, such as death certificates. Using medical examiner/coroner records also allows rapid identification of work-related deaths without waiting several years for mortality data from state offices of vital statistics. Finally, the records are an invaluable data source since they contain detailed information on the nature of the injury, external cause of death, and results of toxicologic testing, which is often not available from other sources. This paper illustrates some of the ways that medical examiner/coroner records are a valuable source of information for epidemiologic studies and makes recommendations to improve their usefulness.
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Affiliation(s)
- C Conroy
- Division of Safety Research, National Institute for Occupational Safety and Health, Morgantown, WV
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Abstract
Although there is considerable information on suicide in the general population, little is known about those who kill themselves at work. This research uses data from the National Traumatic Occupational Fatality data base to describe suicide in the workplace. During 1980 to 1985, 3% of deaths in the NTOF data base were suicides, and the average annual rate was 2.3 per million workers. Risk of workplace suicide increases with increasing age. Men have more than seven times the risk of women; whites have a risk ratio of 1.6 compared with blacks. Women use the same methods but in different proportions than men at work or suicide victims in general. Men in military service and in the agriculture/forestry/fishery industry appear at highest risk of killing themselves at work based on these data.
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Affiliation(s)
- C Conroy
- Division of Safety Research, National Institute for Occupational Safety and Health, Morgantown, WV 26505
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40
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Abstract
We collected data on all residents of San Diego County, California who were hospitalized for or died from a brain injury in 1981. The objectives were to assess the frequency of blood alcohol concentration (BAC) testing and the associations of BAC prevalence with the external cause of the brain injury and case outcome. We found that high BAC levels were most frequent among brain-injured subjects between the ages of 25 and 44 and among those subjects involved in motor vehicle crashes and assaults. Contrary to expectations, injury severity and hospital mortality were inversely related to BAC level, controlling for other predictors. We believe that these inverse associations might be due to differential rates of BAC testing by severity. Among brain-injured survivors with more severe injuries, however, we found that BAC level was positively associated with the prevalence of physician-diagnosed neurological impairment at discharge and with the length of hospitalization.
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Affiliation(s)
- J F Kraus
- Division of Epidemiology, School of Public Health, University of California, Los Angeles 90024
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41
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Conroy C, Kraus JF. Survival after brain injury. Cause of death, length of survival, and prognostic variables in a cohort of brain-injured people. Neuroepidemiology 1988; 7:13-22. [PMID: 3340267 DOI: 10.1159/000110131] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Injuries are the leading cause of death in the United States for those between 1 and 44 years of age and brain injuries are a major component of trauma. This report examines survival in a cohort of San Diego County, California, residents who incurred a brain injury in 1981. Cumulative risk of death over time, using the Cox Proportional Hazards Model, and predictors of death (determined by logistic regression) are used to evaluate survival. The results showed that about half of all brain-injured people who died, died in less than 2 h. Severe overall body damage and severe brain injury are the greatest causes of prehospital death. Even if they survived to the hospital, most people who die have brain injury as their underlying cause of death. Age as well as nature and severity of brain injury are the important predictors of in-hospital death. People who are discharged alive from the hospital have survival comparable to that of the population they came from. However, more die from trauma-related causes than would be expected.
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Affiliation(s)
- C Conroy
- School of Public Health, University of California, Los Angeles
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Kraus JF, Fife D, Conroy C. Pediatric brain injuries: the nature, clinical course, and early outcomes in a defined United States' population. Pediatrics 1987; 79:501-7. [PMID: 3822667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Acute brain injury is the cause of approximately 100,000 pediatric hospital admissions per year in the United States. This report examines the nature of the brain injury, clinical diagnosis, hospital course, and discharge outcome of all pediatric cases in the population of San Diego County, California, for 1981 (N = 709). Brain-injured children were identified from hospital records, death certificates, and coroners' records. Severity of injury was determined using the Abbreviated Injury Scale and the Glasgow Coma Scale. Three percent of brain-injured children died at the accident site; an additional 3% died in the hospital. All in-hospital deaths occurred among the 5% of children with Glascow Coma Scale scores of 8 or less, and in this group the case fatality rate was 59%. Fractures of the skull, present in 23% of cases, seemed to be associated with excess mortality even after type of lesion was considered. Type of lesion, but not presence or absence of a skull fracture, had some predictive power for disability among survivors. Concussion was the most frequent diagnosis. Mildly brain-injured children accounted for 93% of all cases and about 90% of all hospital days.
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Abstract
We performed a population-based study of bicycle-related brain injuries in San Diego, California, residents during 1981. Incidence rates among males were three times higher than for females and were highest at ages 10-14 years for males. Only one-third of bicycle-related brain injuries involved collision with a motor vehicle, and this proportion was independent of age or gender. Brain injuries from motor-vehicle collisions were more severe than those resulting from other causes. Over half the brain-injured bicyclists aged 15 and older who were blood alcohol tested were legally intoxicated.
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Kraus JF, Fife D, Ramstein K, Conroy C, Cox P. The relationship of family income to the incidence, external causes, and outcomes of serious brain injury, San Diego County, California. Am J Public Health 1986; 76:1345-7. [PMID: 3766837 PMCID: PMC1646731 DOI: 10.2105/ajph.76.11.1345] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Among residents of San Diego County, California the incidence and external causes of serious brain injury were related to the median family income of the census tract of residency. Low income tracts had high incidence rates--a finding not changed by adjustment for age and race/ethnicity. For those injured, the type of emergency transport, time from injury to treatment, and outcome of treatment were not related to the median income of the census tract of residency.
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Abstract
The number of fatal brain injuries and hospital admissions for brain injuries in children up to 15 years old in San Diego County, California, were ascertained from emergency room and hospital records, coroners' reports, death certificates, and nursing home and extended-care records for 1981. The annual brain-injury rate per 100 000 children was 185 (235 for boys and 132 for girls). The major causes of pediatric brain injury were falls (35%), recreational activities (29%), and motor vehicle crashes (24%). The case-fatality ratio was six deaths per 100 injured children. Of those children admitted to a hospital alive, 88% had a mild brain injury and 44% had no evidence of loss of consciousness. Two thirds of children with mild brain injuries and one third of those with serious brain injuries were transported to a hospital in private nonemergency vehicles.
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Abstract
Survival time after injury (the time from injury to death) imposes an important constraint on the timing of the delivery of postinjury medical care. From a population-based study of brain-injured people, the survival times in 542 cases with fatal outcomes were studied. Prehospital deaths as well as hospital deaths were included. Survival times were considerably shorter for 95 people with untreatable injuries (Abbreviated Injury Scale level 6) than for the remaining 447 whose injuries were potentially treatable. For the former group, the median survival time was 10 minutes; for the latter, it was 2 hours. For those with potentially treatable injuries, the median time from injury to receiving medical assistance was approximately 30 minutes and 82% received medical assistance within 1 hour of injury. Short survival time was associated with prehospital death, young age, high Injury Severity Score, and having a nonbrain injury as the most severe injury. For patients who arrived alive at a hospital, intracranial surgery was associated with increased survival time.
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Abstract
A protein kinase was identified in mouse organs whose activity is strictly dependent on the presence of Ca++ and phosphatidylserine when assayed at pH 6, and thus has the characteristics of protein kinase C. The relative order of specific activities was brain greater than spleen greater than lung greater than heart, an order similar to that found previously for rat organs. Mice from seven strains had the same level of protein kinase C activity, but strain A/J had half as much activity in each organ as did the other strains. F1 hybrid mice resulting from a cross between A/J and BALB/cByJ mice had levels of activity intermediate to the parental strains, indicating additive inheritance of this genetic difference.
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Conroy C. Book Review: Incontinence and its Management. Br J Occup Ther 1981. [DOI: 10.1177/030802268104400417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Catherine Conroy
- Psychogeriatric Unit, Moorgreen Hospital, Botley Road, West End, Southampton S03 3JB
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Conroy C. Book Review: “Manual of the Clifton Assessment Procedures for the Elderly (Cape)”. Br J Occup Ther 1980. [DOI: 10.1177/030802268004300419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Catherine Conroy
- Senior Occupational Therapist, Moorgreen Hospital, Psychogeriatric Unit, Southampton
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