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Two-part Study (two-part + study)
Selected AbstractsEarly Oral Feeding Following Total Laryngectomy,,THE LARYNGOSCOPE, Issue 3 2001Jesus E. Medina MD Abstract Objectives The time to begin oral feeding after total laryngectomy remains a subject of debate among head and neck surgeons. The prevailing assumption is that early initiation of oral feeding may cause pharyngocutaneous fistula; thus, the common practice of initiating oral feeding after a period of 7 to 10 days. The objective of the study was to demonstrate the feasibility and safety of oral feeding 48 hours after total laryngectomy. Study Design Two-part study includes, first, a sequential study and, second, a prospective analysis of our practice. Methods Patients undergoing total laryngectomy without partial pharyngectomy or radiation treatment (except irradiation through small ports for a T1 or T2 glottic carcinoma) were included. In the first, sequential part of the study (part I), a group of 18 patients who were fed 7 to 10 days after total laryngectomy (control group) was compared with a group of 20 patients who received oral feeding within 48 hours. To confirm the results of part I, a prospective analysis of this practice was conducted (part II) in which 35 additional patients who met the above criteria were fed within 48 hours after surgery. Results In part I, pharyngocutaneous fistula occurred in one patient (5%) in the early feeding group and in two patients (11%) in the control group. In part II, pharyngocutaneous fistula occurred in one patient (2.8%). Overall, fistula occurred in two patients in the combined early feeding group (3.6%). This rate of pharyngocutaneous fistula compares favorably with the fistula rate in the control group of 18 patients. Pharyngeal stricture that required dilation occurred in three of our patients in the study group and two in the control group (5.5% vs. 11%, respectively). The length of hospital stay was significantly shortened from 12 to 7 days. Conclusion Our results indicate that in this patient population initiation of oral feeding 48 hours after total laryngectomy is a safe clinical practice. [source] Television Shopping for Apparel in the United States: Effects of Perceived Amount of Information on Perceived Risks and Purchase IntentionsFAMILY & CONSUMER SCIENCES RESEARCH JOURNAL, Issue 3 2000Minjeong Kim In a two-part study, the amount and types of information available in television-shopping segments selling apparel were examined. In Phase 1, a content analysis of 60 segments selling apparel was conducted. In Phase 2, using an experimental format, a convenience sample of 128 middle-aged women (M = 46 years) viewed a 6-minute television-shopping segment selling apparel and assessed perceived risk, perceived amount of information available in the segment, and purchase intentions, and they answered some open-ended questions about their information-searching activities. Taken together, results of Phases 1 and 2 revealed that when making apparel purchases, participants needed product and customer service information; however, in some segments, that information was never available or was available in less than half the segments coded. Results also revealed that the amount of information perceived from a television-shopping segment selling apparel was negatively related to perceived risk and positively related to purchase intent. [source] Observational relationships between summer and winter monsoons over East Asia.INTERNATIONAL JOURNAL OF CLIMATOLOGY, Issue 4 2005Part I: Basic framework Abstract This paper is the first of a two-part study to investigate the possible relationships between summer and winter monsoons over East Asia during the period 1958 to 1999. It documents the approach employed in the study. Assuming the existence of relationships, the central theme of the study is to answer the questions: Is there evidence for the relationships and, if so, what are the relationships? In particular, the approach used to interpret the available evidence to make inferences about the conditions of the summer monsoon is described. Six winter monsoon categories are defined in terms of the monsoon strength and the conditions of the El Niño,southern oscillation. The conditions of the summer monsoons preceding and following each winter monsoon category are assessed to identify the possible summer-to-winter monsoon and winter-to-summer monsoon relationships respectively. Summer monsoons are classified into unlikely strong (notS) or unlikely weak (notW) according to the bias in the relative occurrence of positive and negative anomalies of several summer monsoon indices. The rainfall condition over China and the characteristics of the subtropical high are also used to provide supplementary evidence for the summer monsoon strength and to describe the accompanying synoptic situations. Copyright © 2005 Royal Meteorological Society. [source] Youth sense of community: Voice and power in community contextsJOURNAL OF COMMUNITY PSYCHOLOGY, Issue 6 2007Scot D. Evans Sense of Community theory suggests that people feel more attracted to groups and settings in which they feel influential or powerful. Unfortunately, young people have no voice or influence in many of the contexts in which they find themselves. Furthermore, teenagers are often unequipped and undersupported to participate fully and feel like they are making meaningful contributions to society. This is especially the case for young people who are disadvantaged or members of a minority groups. A two-part study was undertaken to explore sense of community in adolescents. The first phase utilized existing tools to measure adolescent sense of community in school, neighborhood, and city contexts. The second phase of the study relied on in-depth interviews with teenagers to better understand how they construct their sense of community. This article reports findings from the second phase and looks closely at the sense of community domain of "influence" as it applies to adolescents. Interviews with young people suggest that they feel a stronger self-described sense of community in contexts where they experience voice and resonance, some power and influence, and adequate adult support and challenge. © 2007 Wiley Periodicals, Inc. J Comm Psychol 35: 693,709, 2007. [source] Sexuality and personal relationships for people with an intellectual disability.JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 11 2009Part I: service-user perspectives Abstract Background Despite a recent ideological shift towards the recognition of sexual autonomy for people with an intellectual disability (ID), there are continuing social and cultural barriers to sexual expression. Part I of the current two-part study assessed the sexual knowledge, experiences and aspirations of service users through focus groups and also examined their perceptions of impediments to achieving sexual autonomy. Method Thirty-two participants (20 male, 12 female) attending an ID service participated in focus groups delineated by gender and age group (13,17 years; 18,30 years; 31+ years). Results Analysis of the focus groups showed that service users, especially those over the age of 18 years, had an understanding of their sexual rights but also identified a number of social and cultural barriers that they felt prevent them from achieving sexual autonomy. Those under the age of 18 years had only rudimentary knowledge of sexuality issues, for example pregnancy and sexual anatomy, but aspired to relationships and marriage similar to those over the age of 18 years. Family and staff attitudes appeared to be very influential in the views of respondents. All service users had received some form of sex education, although the benefits of such education appeared most enduring for those over 18 years. Conclusion Service users had an understanding of their sexual rights and the social and environmental barriers that prevent them from fulfilling their rights. The provision of sex education training and promotion of positive attitudes towards appropriate sexual expression is critical to the realization of sexual autonomy for people with an ID. [source] Older persons' experiences of whole systems: the impact of health and social care organizational structuresJOURNAL OF NURSING MANAGEMENT, Issue 2 2008BRENDAN McCORMACK BSc (Hons) Nursing, DPhil (Oxon) Aim(s), An in-depth case study of whole systems working. Background, This paper reports on the second part of a two-part study exploring whole systems working. Part 1 of the study focused on an in-depth review of the literature pertaining to continuity of care and service integration. The second part, reported here, focused on an in-depth case study of one whole system. Evaluation, Informed by the findings of part 1 of the study, data collection methods included in-depth interviews, real-time tracking of 18 older people, focus groups and consensus conferencing. Different data sets were analysed individually and synthesized using matrices derived from the literature review findings. Key issue(s), Key themes from data synthesis include: (1) access to the most appropriate services; (2) service fragmentation; (3) continuity of care; and (4) routinized care. Conclusion(s), The four themes of the case study reflect the need to address issues of demarcation of professional responsibilities, complicated channels of communication, information flows, assessment and reassessment in whole systems working. Implications for nursing management, The impact of disempowering relationships on actual continuity of care and perceptions of quality among service users and providers. Lessons need to be learnt from specialist services and applied to service delivery in general. [source] The role and scope of the clinical nurse consultant in Wentworth area health service, New South Wales, AustraliaJOURNAL OF NURSING MANAGEMENT, Issue 1 2007GradDipClinNsg, JENNY O'BAUGH RN, OncNsgCert Aims, This paper reports phase one of a two-part study in a New South Wales area health service, which aimed to evaluate the grading system for clinical nurse consultants. Background, Since its inception in 1986, the role and scope of practice of clinical nurse consultants in New South Wales has been viewed with differing expectations leading to role conflict from the nurse consultants themselves and others in health care including managers and other clinicians. Method, A quantitative approach was used for this study. A survey comprising of open and closed questions was mailed to all clinical nurse consultants (n = 42) employed in the area. Results, The data presented suggest that ambiguity continues about the role, the scope and the differences within the grading system of clinical nurse consultants. Conclusions, Clinical nurse consultants need leadership training and support from their managers to fulfil their role. More work is required to clarify the role of clinical nurse consultants. [source] Effects of linearly polarized 0.6,1.6 ,M irradiation on stellate ganglion function in normal subjects and people with complex regional pain (CRPS I)LASERS IN SURGERY AND MEDICINE, Issue 5 2003Jeffrey R. Basford MD Abstract Background and Objectives Stellate ganglion blocks are an effective but invasive treatment of upper extremity pain. Linearly polarized red and near-infrared (IR) light is promoted as a safe alternative to this procedure, but its effects are poorly established. This study was designed to assess the physiological effects of this latter approach and to quantitate its benefits in people with upper extremity pain due to Complex Regional Pain Syndrome I (CRPS I, RSD). Study Design/Materials and Methods This was a two-part study. In the first phase, six adults (ages 18,60) with normal neurological examinations underwent transcutaneous irradiation of their right stellate ganglion with linearly polarized 0.6,1.6 ,m light (0.92 W, 88.3 J). Phase two consisted of a double-blinded evaluation of active and placebo radiation in 12 subjects (ages 18,72) of which 6 had upper extremity CRPS I and 6 served as "normal" controls. Skin temperature, heart rate (HR), sudomotor function, and vasomotor tone were monitored before, during, and for 30 minutes following irradiation. Analgesic and sensory effects were assessed over the same period as well as 1 and 2 weeks later. Results Three of six subjects with CRPS I and no control subjects experienced a sensation of warmth following active irradiation (P,=,0.025). Two of the CRPS I subjects reported a >50% pain reduction. However, four noted minimal or no change and improvement did not reach statistical significance for the group as a whole. No statistically significant changes in autonomic function were noted. There were no adverse consequences. Conclusions Irradiation is well tolerated. There is a suggestion in this small study that treatment is beneficial and that its benefits are not dependent on changes in sympathetic tone. Further evaluation is warranted. Lasers Surg. Med. 32:417,423, 2003. © 2003 Wiley-Liss, Inc. [source] Strategic light manipulation as a restoration strategy to reduce alien grasses and encourage native regeneration in Hawaiian mesic forestsAPPLIED VEGETATION SCIENCE, Issue 3 2010S. McDaniel Abstract Question: Is there a light level at which alien grass biomass is reduced while still supporting growth and survival of native woody species, allowing for native species regeneration in abandoned pastures? Location: Island of Hawaii, USA. Methods: In a two-part study we examined the effect of light availability on common native woody and alien grass species found in secondary forests in Hawaii. A field survey was conducted to examine the relationship between light availability and canopy type (open pasture, planted canopy and secondary forest) on understory grass biomass and litter accumulation. We then experimentally manipulated light levels to determine the effect of light availability on growth and survival of six native woody species and three alien grasses. Low-light (5%), medium-light (10%) and high-light (20-30%) treatments were created using shade structures erected beneath the existing secondary koa canopy. Results: In the field survey, alien grass biomass was greatest under the open pasture and lowest in the secondary forest. There was a positive correlation between understory light availability and alien grass biomass. In the experimental study, large reductions in relative growth rates were documented for all of the grass species and four of the six woody species under the lowest light level. Although growth at 5% light is substantially reduced, survival is still high (84-100%), indicating that these species may persist under closed canopy. Conclusion: Low-light conditions result in the greatest reduction in alien grass biomass while creating an environment in which native woody species can grow and survive. [source] Detection of Undiagnosed Diabetes and Prediabetic States in High-risk Emergency Department PatientsACADEMIC EMERGENCY MEDICINE, Issue 5 2009Michelle A. Charfen MD Abstract Background:, Diabetes is often not diagnosed until complications appear, and one-third of those with diabetes may be undiagnosed. Prediabetes and diabetes are conditions in which early detection would be appropriate, because the duration of hyperglycemia is a predictor of adverse outcomes, and there are effective interventions to prevent disease progression and to reduce complications. Objectives:, The objectives were to determine the prevalence of diabetes mellitus and prediabetes in emergency department (ED) patients with an elevated random glucose or risk factors for diabetes but without previously diagnosed diabetes and to identify which at-risk ED patients should be considered for referral for confirmatory diagnostic testing. Methods:, This two-part study was composed of a prospective 2-year cohort study, and a 1-week cross-sectional survey substudy, set in an urban ED in Los Angeles County, California. A convenience sample was enrolled of 528 ED patients without previously diagnosed diabetes with either 1) a random serum glucose , 140 mg/dL regardless of the time of last food intake or a random serum glucose , 126 mg/dL if more than 2 hours since last food intake or 2) at least two predefined diabetes risk factors. Measurements included presence of diabetes risk factors, ED glucose, cortisol, insulin and glycosylated hemoglobin (HbA1c), and 2-hour oral glucose tolerance test results, administered at 6-week follow-up. Results:, Glycemic status was confirmed at follow-up in 256 (48%) of the 528 patients. Twenty-seven (11%) were found to have diabetes, 141 (55%) had prediabetes, and 88 (34%) had normal results. Age, ED glucose, HbA1c, cortisol, and random serum glucose , 140 mg/dL were associated with both diabetes and prediabetes on univariate analysis. A random serum glucose , 126 mg/dL after 2 hours of fasting was associated with diabetes but not prediabetes; ED cortisol, insulin, age , 45 years, race, and calculated body mass index (BMI) were associated with prediabetes but not diabetes. In multivariable models, among factors measurable in the ED, the only independent predictor of diabetes was ED glucose, while ED glucose, age , 45 years, and symptoms of polyuria and polydipsia were independent predictors of prediabetes. All at-risk subjects with a random ED blood glucose > 155 mg/dL had either prediabetes or diabetes on follow-up testing. Conclusions:, A substantial fraction of this urban ED study population was at risk for undiagnosed diabetes and prediabetes, and among the at-risk patients referred for follow-up, the majority demonstrated diabetes or prediabetes. Notably, all patients with two risk factors and a random serum glucose > 155 mg/dL were later diagnosed with prediabetes or diabetes. Consideration should be given to referring ED patients with risk factors and a random glucose > 155 mg/dL for follow-up testing. [source] | |||||||||||||