RESUMEN
The objective of this study was to evaluate the fermentation dynamics of 2 commonly fed corn (co)products in their intact and defatted forms, using the in vitro gas production (IVGP) technique, and to investigate the shifts of the predominant rumen bacterial populations using the 16S rDNA bacterial tag-encoded FLX amplicon pyrosequencing (bTEFAP) technique. The bTEFAP technique was used to determine the bacterial profile of each fermentation time at 24 and 48 h. Bacterial populations were identified at the species level. Species were grouped by substrate affinities (guilds) for cellulose, hemicellulose, pectin, starch, sugars, protein, lipids, and lactate. The 2 (co)products were a dried distillers grain (DDG) plus solubles produced from a low-heat drying process (BPX) and a high-protein DDG without solubles (HP). Chemical analysis revealed that BPX contained about 11.4% ether extract, whereas HP contained only 3.88%. Previous studies have indicated that processing methods, as well as fat content, of corn (co)products directly affect fermentation rate and substrate availability, but little information is available regarding changes in rumen bacterial populations. Fermentation profiles of intact and defatted BPX and HP were compared with alfalfa hay as a standard profile. Defatting before incubation had no effect on total gas production in BPX or HP, but reduced lag time and the fractional rate of fermentation of BPX by at least half, whereas there was no effect for HP. The HP feed supported a greater percentage of fibrolytic and proteolytic bacteria than did BPX. Defatting both DDG increased the fibrolytic (26.8 to 38.7%) and proteolytic (26.1 to 37.2%) bacterial guild populations and decreased the lactate-utilizing bacterial guild (3.06 to 1.44%). Information regarding the fermentation kinetics and bacterial population shifts when feeding corn (co)products may lead to more innovative processing methods that improve feed quality (e.g., deoiling) and consequently allow greater inclusion rates in dairy cow rations.
Asunto(s)
Fermentación , Gases/metabolismo , Rumen/metabolismo , Rumen/microbiología , Zea mays/metabolismo , Alimentación Animal/análisis , Fenómenos Fisiológicos Nutricionales de los Animales , Animales , Técnicas de Tipificación Bacteriana/veterinaria , Bovinos , ADN Bacteriano/análisisRESUMEN
We report a patient with scleroderma, renal cell carcinoma (RCC) and membranous nephropathy (MN). Certain clinical and laboratory features suggested that RCC caused or enhanced the other two conditions. A 55-year-old man developed scleroderma which progressed rapidly during its first 2 years with development of hypertension and acute renal failure, peak serum creatinine (SCr) 327 micromol/l (3.7 mg/dl) and partial improvement of the renal function (SCr 239 micromol/l or 2.7 mg/dl) after initiation of an angiotensin converting enzyme inhibitor. He subsequently developed nephrotic syndrome (urine protein excretion 9 gm/24-h) and progressive renal failure, with SCr 469 +/- 18 micromol/l (5.3 +/- 0.2 mg/dl). An anti-nuclear mitotic apparatus protein (NUMA) antibody, which is uncommon in scleroderma but has been linked to certain malignancies, was found in his serum. A left upper pole RCC was removed by heminephrectomy. MN was found in the renal parenchyma adjacent to the excised tumor. In the 3.5 years following surgery, the clinical manifestations of scleroderma have been arrested while the medications prescribed for this condition have been greatly reduced. Proteinuria is consistently less than 1 gm/24-h and 42 months after surgery serum creatinine was 256 micromol/l (2.9 mg/dl). Nutrition has also improved. Although this case may represent chance occurrence of three uncommon diseases (scleroderma, RCC, MN) in the same individual, the sustained improvement of the manifestations of scleroderma and MN after resection of the RCC contrasted to the rapid course of these conditions until the surgery, and the presence in the patient's serum of an autoantibody which is uncommon in patients with scleroderma, but has been linked to malignancy, suggest a pathogenetic relationship between the three conditions.
Asunto(s)
Carcinoma de Células Renales/complicaciones , Carcinoma de Células Renales/patología , Glomerulonefritis Membranosa/complicaciones , Neoplasias Renales/complicaciones , Neoplasias Renales/patología , Esclerodermia Sistémica/complicaciones , Carcinoma de Células Renales/terapia , Glomerulonefritis Membranosa/diagnóstico , Glomerulonefritis Membranosa/terapia , Humanos , Neoplasias Renales/terapia , Masculino , Persona de Mediana Edad , Esclerodermia Sistémica/diagnóstico , Esclerodermia Sistémica/terapiaAsunto(s)
Infarto del Miocardio/terapia , Reperfusión Miocárdica , Terapia Trombolítica , Tomografía Computarizada de Emisión , Anciano , Circulación Coronaria , Femenino , Corazón/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/tratamiento farmacológico , Ensayos Clínicos Controlados Aleatorios como Asunto , Radioisótopos de Rubidio , Resultado del TratamientoRESUMEN
OBJECTIVES: We sought to directly compare primary stenting with accelerated tissue plasminogen activator (t-PA) in patients presenting with acute ST-elevation myocardial infarction (AMI). BACKGROUND: Thrombolysis remains the standard therapy for AMI. However, at some institutions primary angioplasty is favored. Randomized trials have shown that primary angioplasty is equal or superior to thrombolysis, while recent studies demonstrate that stent implantation improves the results of primary angioplasty. METHODS: Patients presenting with AMI were randomly assigned to primary stenting (n = 62) or accelerated t-PA (n = 61). The primary end point was the composite of death, reinfarction, stroke or repeat target vessel revascularization (TVR) for ischemia at six months. RESULTS: The primary end point was significantly reduced in the stent group compared with the accelerated t-PA group, 24.2% versus 55.7% (p < 0.001). The event rates for other outcomes in the stent group versus the t-PA group were as follows: mortality: 4.8% versus 3.3% (p = 1.00); reinfarction: 6.5% versus 16.4% (p = 0.096); stroke: 1.6% versus 4.9% (p = 0.36); recurrent unstable ischemia: 9.7% versus 26.2% (p = 0.03) and repeat TVR for ischemia: 14.5% versus 49.2% (p < 0.001). The median length of the initial hospitalization was four days in the stent group and seven days in the t-PA group (p < 0.001). CONCLUSIONS: Compared with accelerated t-PA, primary stenting reduces death, reinfarction, stroke or repeat TVR for ischemia. In centers where facilities and experienced interventionists are available, primary stenting offers an attractive alternative to thrombolysis.
Asunto(s)
Infarto del Miocardio/terapia , Stents , Terapia Trombolítica , Anciano , Angiografía Coronaria , Femenino , Fibrinolíticos/uso terapéutico , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/tratamiento farmacológico , Infarto del Miocardio/mortalidad , Oportunidad Relativa , Recurrencia , Stents/efectos adversos , Accidente Cerebrovascular/etiología , Tasa de Supervivencia , Terapia Trombolítica/efectos adversos , Activador de Tejido Plasminógeno/uso terapéutico , Resultado del TratamientoRESUMEN
Pulmonary capillary hemangiomatosis (PCH) typically occurs in young patients who have signs and symptoms of pulmonary hypertension. It commonly is misdiagnosed in life as pulmonary veno-occlusive disease, and the correct diagnosis usually is not made until autopsy. Autopsy records, including reports, gross photographs, histologic slides, clinical histories, and radiographic images, were reviewed to identify cases with morphologic changes characteristic of PCH. The previous case reports describe PCH as a diffuse process throughout both lung fields. All patients were symptomatic, and most died of the disease. This article details 8 cases of PCH-like foci that were incidental findings at autopsy in which the patients did not have symptoms of pulmonary hypertension nor did PCH contribute in any way to death. This is the first case series that describes pathologic changes of PCH occurring in this setting, and we hope to provide more interest in PCH and its natural history.
Asunto(s)
Hemangioma Capilar/diagnóstico , Neoplasias Pulmonares/diagnóstico , Anciano , Autopsia , Diagnóstico Diferencial , Hemangioma Capilar/patología , Humanos , Pulmón/patología , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana EdadAsunto(s)
Células Sanguíneas/citología , Fibroblastos/citología , Leucocitos/citología , Adulto , Antígenos CD/metabolismo , Células Sanguíneas/metabolismo , Células Sanguíneas/virología , Tamaño de la Célula , Femenino , Fibroblastos/metabolismo , Fibroblastos/virología , Humanos , Inmunofenotipificación , Leucocitos/metabolismo , Leucocitos/virología , Microscopía Electrónica , Spumavirus/aislamiento & purificaciónRESUMEN
Periorbital edema associated with lupus erythematosus is not frequently reported. To our knowledge, periorbital edema from increased dermal mucin has not been reported with any form of lupus. We present a patient with discoid lupus exhibiting periorbital edema from massive mucinosis.
Asunto(s)
Lupus Eritematoso Discoide/complicaciones , Mucinosis/complicaciones , Enfermedades Orbitales/complicaciones , Enfermedad Aguda , Adulto , Edema/complicaciones , Femenino , Humanos , Mucinosis/patología , Enfermedades Orbitales/patologíaAsunto(s)
Autopsia , Enfermedad Coronaria/diagnóstico , Paro Cardíaco/etiología , Síndrome del Corazón Izquierdo Hipoplásico/diagnóstico , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/patología , Diagnóstico Diferencial , Hemangioma Capilar/diagnóstico , Humanos , Síndrome del Corazón Izquierdo Hipoplásico/complicaciones , Síndrome del Corazón Izquierdo Hipoplásico/patología , Neoplasias Pulmonares/diagnóstico , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Inflammatory breast cancer is a locally advanced tumor with an aggressive local and systemic course. Treatment of this disease has been evolving over the last several decades. The aim of this study was to assess whether current therapies, both surgical and chemotherapeutic, are providing better local control (LC) and overall survival (OS). We also attempted to identify clinical and pathologic factors that may be associated with improved OS, disease-free survival (DFS), and LC. METHODS: A 25-year retrospective review performed at the City of Hope National Medical Center identified 90 patients with the diagnosis of inflammatory breast cancer. RESULTS: Of the 90 patients identified with inflammatory breast cancer, 33 received neoadjuvant therapy (NEO) consisting of chemotherapy followed by surgery with radiation (n = 26) and without radiation (n = 7). Fifty-seven patients received other therapies (nonNEO). Treatments received by the nonNEO group consisted of chemotherapy, radiation, mastectomy, adrenalectomy, and oophorectomy, alone or in combination. The median follow-up was 28.9 months for the NEO group and 17.6 months for the nonNEO group. Borderline significant differences in the OS distributions between the two groups were found (P = .10), with 3- and 5-year OS for the NEO group of 40.0% and 29.9% and for the nonNEO group of 24.7% and 16.5%, respectively. DFS and LC were comparable in the two groups. Lower stage was associated with an improved OS (P < .05). The 5-year OS for stage IIIB was 30.9%, compared to 7.8% for stage IV. In those patients with stage III disease who were treated with mastectomy and rendered free of disease, margin status was identified by univariate analysis to be a prognostic indicator for OS (P < .05). The 3-year OS, DFS, and LC for patients with negative margins were 47.4%, 37.5%, and 60.3%, respectively, compared to 0%, 16.7%, and 31.3% in patients with positive margins. CONCLUSIONS: This study suggests that in patients with inflammatory breast cancer and nonmetastatic disease, an aggressive surgical approach may be justified with the goal of a negative surgical margin. Achievement of this local control is associated with a better overall outcome for this subset of patients. The ability to obtain negative margins may further identify a group of patients with a less aggressive tumor biology that may be more responsive to other modalities of therapy.
Asunto(s)
Neoplasias de la Mama/terapia , Evaluación de Resultado en la Atención de Salud , Adulto , Anciano , Análisis de Varianza , Antineoplásicos/uso terapéutico , Neoplasias de la Mama/mortalidad , Supervivencia sin Enfermedad , Femenino , Humanos , Modelos Logísticos , Los Angeles/epidemiología , Mastectomía , Persona de Mediana Edad , Terapia Neoadyuvante , Recurrencia Local de Neoplasia/epidemiología , Estadificación de Neoplasias , Radioterapia Adyuvante , Análisis de Regresión , Estudios Retrospectivos , Factores de Riesgo , Tasa de SupervivenciaRESUMEN
Stenting of saphenous vein graft (SVG) lesions is associated with significant clinical events at late follow-up. We sought to determine predictors of clinical outcome after this procedure. One hundred twenty-eight balloon-expandable stents were implanted in the SVGs of 106 patients. Baseline clinical and angiographic characteristics were analyzed. All grafts, including those not stented, were scored for extent of disease involving the luminal surface of the graft, and for the presence of low profile lesions (< 50% graft stenosis) and/or high profile lesions (> or = 50% graft stenosis). The in-hospital success rate was 98.1%. Before discharge, no patient died, required bypass surgery, or had repeat angioplasty of the same graft. Follow-up was obtained on all the patients. At a median of 18 months, 15% had died, 17% had experienced myocardial infarction, 20% had required repeat bypass surgery, and 37% needed repeat angioplasty to either the same site or a different lesion. Event-free survival was recorded in only 44% of the patients. The cumulative Kaplan-Meier survival at 2.4 years was 78.7%. Using the Cox proportional hazards model, predictors of survival were the absence of a high profile lesion in any nonstented patent graft (p = 0.004), and the use of lipid-lowering agents at follow-up (p = 0.01). Stenting SVG lesions can be performed with a high degree of procedural success, but at long-term follow-up there is a high rate of cardiac events. The absence of a high profile lesion in any nonstented patent graft is the strongest predictor of survival.
Asunto(s)
Puente de Arteria Coronaria , Enfermedad Coronaria/cirugía , Vena Safena/trasplante , Stents , Angioplastia Coronaria con Balón , Angiografía Coronaria , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/métodos , Enfermedad Coronaria/diagnóstico por imagen , Enfermedad Coronaria/patología , Femenino , Estudios de Seguimiento , Predicción , Oclusión de Injerto Vascular/diagnóstico por imagen , Oclusión de Injerto Vascular/patología , Oclusión de Injerto Vascular/prevención & control , Humanos , Hipolipemiantes/uso terapéutico , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Infarto del Miocardio/etiología , Modelos de Riesgos Proporcionales , Reoperación , Retratamiento , Vena Safena/patología , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
Iron uptake by cells may increase the intracellular pool of prooxidant iron prior to storage of iron within ferritin. Because hyperoxia is toxic to alveolar macrophages (AM) via mechanisms involving oxidant stress, we hypothesized that iron uptake by AM might promote hyperoxia-induced injury. To assess this hypothesis, we cultured AM recovered from healthy volunteers under conditions of normoxia or hyperoxia (60% or 95% oxygen) in media of varying iron content, including control media (3 microM iron) and media supplemented with iron (FeCl3; total iron 10, 20, or 40 microM). AM injury was assessed by measuring release of lactate dehydrogenase (LDH), phagocytic activity for yeast, and cytosolic concentrations of calcium ([Ca2+]i) as determined by ratio image analysis of AM loaded with the fluorescent calcium probe indo-1. There was dose-dependent accumulation of iron and ferritin synthesis in AM exposed to iron-supplemented media. Exposure of AM to hyperoxia (60% and 95% oxygen, 18 h) in control media increased LDH release and impaired phagocytic activity for yeast; however, similar hyperoxic exposures in iron-supplemented media significantly increased the cells' LDH release and decreased phagocytosis. Exposure to 95% oxygen increased the [Ca2+]i of AM over 18 h, but similar exposure in iron-supplemented media induced greater increases in [Ca2+]i. As compared with exposure to normoxia, exposure to hyperoxia (60% and 95% oxygen) also decreased iron uptake and, to a greater extent, ferritin synthesis by AM in iron-supplemented media. These data suggest that: (1) iron uptake promotes hyperoxic injury to AM; and (2) hyperoxia impairs the capacity of AM to sequester iron in ferritin.
Asunto(s)
Hiperoxia/metabolismo , Hiperoxia/patología , Hierro/farmacocinética , Macrófagos Alveolares/metabolismo , Macrófagos Alveolares/patología , Líquido del Lavado Bronquioalveolar/citología , Calcio/metabolismo , Ferritinas/biosíntesis , Humanos , Membranas Intracelulares/metabolismo , Hierro/metabolismo , L-Lactato Deshidrogenasa/metabolismo , Concentración Osmolar , Fagocitosis/fisiología , Saccharomyces cerevisiae/fisiología , Transferrina/farmacologíaRESUMEN
OBJECTIVE: To examine the procedural and long term success of coronary stenting in patients presenting with unstable angina and the effect of warfarin on the clinical outcome of these high risk patients. DESIGN: A nonrandomized, retrospective analysis of patients presenting with unstable angina. SETTING: A tertiary care, Canadian university-affiliated teaching hospital. PATIENTS: Of 1250 patients who underwent percutaneous transluminal coronary angioplasty between January 1994 and June 1995, 365 underwent coronary stenting. The study population consisted of the 156 patients presenting with unstable angina who underwent coronary stenting. Patients with Canadian Cardiovascular Society class IV and postinfarction angina were included. INTERVENTIONS: Stent delivery by standard techniques to the target lesion was successful in all patients. At discharge, 88 patients were prescribed warfarin, ticlopidine and acetylsalicylic acid (ASA); the remaining 68 patients received only ticlopidine and ASA. Late clinical outcomes were assessed by telephone interview. RESULTS: The overall procedural success rate was 96%. One patient died in hospital (0.6%). Other events were abrupt closure (1.9%), myocardial infarction (1.9%) and urgent bypass surgery (1.9%). During follow-up, target vessel reintervention was needed in 19.6% of patients. Early and late clinical outcomes did not differ significantly between anticoagulated patients and those treated with antiplatelet agents alone, but anticoagulated patients had a significantly longer hospital stay. CONCLUSIONS: Coronary stenting in patients with unstable angina was associated with excellent procedural success and favourable late clinical outcomes. Warfarin added no apparent additional clinical benefit to antiplatelet agents in this high risk population.
Asunto(s)
Angina Inestable/cirugía , Angioplastia Coronaria con Balón , Enfermedad Coronaria/cirugía , Infarto del Miocardio/complicaciones , Stents , Angina Inestable/etiología , Aspirina/administración & dosificación , Puente de Arteria Coronaria , Estudios de Seguimiento , Humanos , Infarto del Miocardio/cirugía , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/cirugía , Reoperación , Estudios Retrospectivos , Ticlopidina/administración & dosificación , Resultado del Tratamiento , Warfarina/administración & dosificaciónRESUMEN
Rumination, or the chewing and re-swallowing of regurgitated stomach contents, can be found in up to 10% of institutionalized individuals with severe or profound mental retardation. Serious physical consequences, including death, can result from the disorder. Unfortunately, rumination can be subtle and difficult to observe and often continues untreated. Additionally, the research literature has provided divergent results without clear treatment guidance for clinicians. We present an overview of the history of rumination, a review of the literature on its etiology and treatment, and recommendations for future research.
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Trastornos de Ingestión y Alimentación en la Niñez/terapia , Adulto , Terapia Conductista , Trastornos de Ingestión y Alimentación en la Niñez/etiología , Trastornos de Ingestión y Alimentación en la Niñez/historia , Predicción , Historia del Siglo XVII , Historia del Siglo XVIII , Historia del Siglo XIX , Historia del Siglo XX , Humanos , Discapacidad Intelectual/psicología , Psicoterapia , Proyectos de Investigación , Instituciones Residenciales , SaciedadRESUMEN
The thrombotic coronary accident that triggers a myocardial infarction initiates a 'wavefront' of ischaemic cell death that can be aborted by timely restoration of blood flow. Myocardium destined for necrosis can be salvaged by quick lysis of the culprit clot to restore perfusion, reduce infarct size and save lives. While a number of useful thrombolytic regimens have been investigated, the greatest barrier to optimising efficacy is reducing the delay between the onset of symptoms and administration of thrombolytic therapy. Clinical experience has confirmed laboratory evidence that prompt restoration of coronary blood flow can salvage more than 50% of ischaemic myocardium if achieved within 2 hours. However, after 6 hours of sustained ischaemia, the opportunity to achieve meaningful salvage is largely lost. Analysis of pooled data estimates that for each hour of delay 1.6 fewer lives are saved per 1000 patients treated. Other investigators have estimated 60 to 80 lives saved per 1000 patients treated within 1 hour of symptom onset. More realistically, the time from symptom onset to treatment averages 2.5 to 5 hours in various studies. Reluctance to seek medical help results in a delay of more than 4 hours in at least 40% of patients. There may be some benefits of late, time-independent reperfusion from 12 to 24 hours after symptoms. Some hibernating myocardium may be salvaged resulting in less adverse late ventricular remodelling, reduced infarction expansion and improved electrical stability. Barriers to timely thrombolytic treatment may be classified as presentation delay or treatment delay. Strategies to optimise timely treatment have included pre-hospital administration of thrombolytics. This achieves greatest benefit when used in a more rural setting where transportation times tend to be longer. In this setting, as much as 140 minutes has been shaved off the symptom-to-needle time with a 50% reduction in 3-month mortality sustained as a 30% reduction in 5-year mortality. Most hospitals can improve their treatment (door-to-needle) time by focusing on chronic sources of delay. An emergency room culture of quick, coordinated response to chest pain must involve registration clerks, triage nurses, ECG technicians and emergency physicians. The authority to decide thrombolytic therapy must reside with the primary care physicians in any emergency room that encounters an acute infarction. The profound, life-saving benefits of thrombolytic therapy when used in a timely way should evoke a new sense of urgency in medical personnel when encountering the individual with a potential myocardial infarction.
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Infarto del Miocardio/terapia , Terapia Trombolítica/métodos , Terapia Trombolítica/normas , Enfermedad Aguda , Humanos , Guías de Práctica Clínica como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de TiempoRESUMEN
OBJECTIVES: This study sought to assess the late clinical and angiographic outcomes of patients who received stents within the first week of acute myocardial infarction (AMI). BACKGROUND: Recent studies have demonstrated that stenting of the infarct-related artery is a useful adjunct to balloon angioplasty in patients with AMI. However, there are limited data on the late clinical and angiographic outcomes of these patients. METHODS: Between January 1994 and September 1995, 32 patients at our institution underwent stenting of the infarct-related artery within 1 week of AMI: 13 within 14 hours (evolving group) and 19 between days 2 and 7 (recent AMI group). Late clinical follow-up was obtained on all survivors. Quantitative angiographic measurements were recorded on the stented segments before stenting, immediately after stenting, and on the follow-up angiograms. RESULTS: At 13.1+/-6.4 months from the time of stenting, three patients died and three required repeat angioplasty, but no patient had reinfarction or required bypass surgery. At follow-up 26 (81%) of 32 patients remained free of major cardiac events; of these, 24 (92%) were free of angina. Repeat angiography performed at 10.8+/-7.5 months in 26 (87%) of 30 discharged patients showed that all infarct-related arteries were patent and the restenosis rate was low: 22% in the 13 patients with evolving AMI (<14 hours) and 12% in the 19 patients with recent AMI (days 2 through 7). CONCLUSION: In this study stenting of the infarct-related artery in patients with evolving and recent AMI was associated with a favorable late clinical outcome. Patency of the infarct-related artery was well maintained, and the restenosis rate was low.
Asunto(s)
Angiografía Coronaria , Infarto del Miocardio/cirugía , Stents , Angioplastia Coronaria con Balón , Anticoagulantes/uso terapéutico , Femenino , Fibrinolíticos/uso terapéutico , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/tratamiento farmacológico , Estudios Prospectivos , Recurrencia , Terapia Trombolítica , Resultado del TratamientoRESUMEN
PURPOSE: To describe the new definition of mental retardation developed by the American Association of Mental Retardation (AAMR) published in 1992. The previous definition was based on a deficiency model that identified "subaverage intelligence" using an intelligence quotient (IQ) score equal to or less than 70. The new definition places greater emphasis on adaptive skills and environmental support needs. SCOPE: Defining mental retardation according to AAMR criteria reflects a significant paradigm shift from an absolute trait to a functional conception. The new definition is dynamic, attends to context, is inherently holistic--and, therefore--closely aligned with nursing theory. Diagnosis is a three-step process by which functional strengths and weaknesses are identified along 4 dimensions and 10 adaptive-skill areas. Identification of needed supports is incorporated within the three-step process. CONCLUSIONS: Nurses can enhance holistic care by working to have AAMR's new definition adopted by government legislators and administrators of state and county agencies that provide mental-retardation services. Nurses should become active participants as interdisciplinary diagnostic team members as well as case managers. Nurse researchers and educators can contribute toward further developing AAMR's definition by standardizing assessment instruments, working to make diagnostic procedures more user-friendly, and researching the construct validity of adaptive-skill areas. Finally, nurses should help legislators and policy makers understand the sociocultural ramifications of AAMR's new definition.
Asunto(s)
Discapacidad Intelectual/diagnóstico , Terminología como Asunto , Actividades Cotidianas , Personas con Discapacidad/legislación & jurisprudencia , Guías como Asunto , Humanos , Discapacidad Intelectual/enfermería , Valores Sociales , Estados UnidosRESUMEN
A simplified version of Azrin and Foxx's method of toilet training was evaluated in an adult with profound mental retardation. An ABAB reversal design was used to evaluate intervention effects. Results indicated that the procedure was effective in reducing toileting accidents and in increasing appropriate urinations. Additionally, continence was maintained at a 3 month follow-up evaluation.