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Biomedical subjects

A Adams

Publications and source records attributed to A Adams.

At least 37 records · Page 2Linked to original sources
PubMed1998

Nursing organizational practice and its relationship with other features of ward organization and job satisfaction.

This paper describes a new classification of ward organizational practice in nursing. Data related to aspects of ward nursing practice were collected by postal survey from a nationally representative sample of 74 acute hospital wards, and subjected to hierarchical cluster analysis. The model which was deemed to best 'fit' the data, provided three types of ward practices, which have been named: 'devolved', 'two tier' and 'centralized' nursing. The distinguishing features of the three classifications are similar but not identical to accepted 'ideal types' of primary, team and functional systems. The relationships between wards in each of the three identified categories and other ward organizational practice processes of nursing care and job satisfaction are described.

Analysis of Variance↗
PubMed1998

Alcohol counseling: physicians will do it.

OBJECTIVE: To assess the use of a brief provider-delivered alcohol counseling intervention of 5 to 10 minutes with high-risk drinking patients by primary care provider* trained in the counseling intervention and provided with an office support system. DESIGN: A group randomized study design was used. Office sites were randomized to either a usual care or special intervention condition, within which physicians and patients were nested. The unit of analysis was the patient. SETTING: Primary care internal medicine practices affiliated with an academic medical center. PARTICIPANTS: Twenty-nine providers were randomized by practice site to receive training and an office support system to provide an alcohol counseling special intervention or to continue to provide usual care. INTERVENTION: Special intervention providers received 2 1/2 hours of training in a brief alcohol-counseling intervention and were then supported by an office system that screened patients, cued providers to intervene, and made patient education materials available as tip sheets. MEASUREMENTS AND MAIN RESULTS: Implementation of the counseling steps was measured by patient exit interviews (PEI) immediately following the patient visit. The interval between the date of training and the date of the PEI ranged from 6 to 32 months. Special intervention providers were twice as likely as usual care providers to discuss alcohol use with their patients. They carried out every step of the counseling sequence significantly more often than did usual care providers (p < .001). This intervention effect persisted over the 32 months of follow-up. CONCLUSIONS: Physicians and other health-care providers trained in a brief provider-delivered alcohol intervention will counsel their high-risk drinking patients when cued to do so and supported by a primary care office system.

Adult↗
PubMed1998

Are the features of ankyloglossia limited to the lingual fraenum?

A 16-year-old male patient presented with ankyloglossia accompanied by a complaint of forceful spurting of saliva from the mouth and a unilateral swelling in the submandibular region. Following surgical relief of the ankyloglossia, the spurting of saliva had virtually ceased and the submandibular swelling disappeared without recurrence.

Adolescent↗
PubMed1998

A comparative study of chiropractic and medical education.

BACKGROUND: Chiropractic is the largest of the alternative/complementary health professions in North America. However, little attention has been given in the health sciences literature to the formal curriculum of chiropractic education or to its similarities to and differences from the curriculum of allopathic medical education. This lack of information precludes extensive referrals and interaction between the 2 professions, even when historical and political barriers can be overcome. METHOD: This is a descriptive, comparative study of the curriculum content of North American chiropractic and medical colleges, supplemented by in-depth data obtained through site visits with 6 institutions (3 chiropractic and 3 medical). DISCUSSION: Considerable commonality exists between chiropractic and medical programs. Regarding the basic sciences, these programs are more similar than dissimilar, both in the types of subjects offered and in the time allotted to each subject. The programs also share some common areas in the clinical sciences. Chiropractic and allopathic medicine differ the greatest in clinical practice, which in medical school far exceeds that in chiropractic school. The therapies that chiropractic and medical students learn are distinct from one another, and the settings in which students receive clinical training are different and isolated from one another. With these similarities and differences established, future studies should examine the quality of the 2 educational programs in detail.

Chiropractic↗
PubMed1997

Provider training for patient-centered alcohol counseling in a primary care setting.

OBJECTIVE: To assess the impact of a brief training program on primary care providers' skills, attitudes, and knowledge regarding high-risk and problem drinking. DESIGN: Training plus pretesting and posttesting for program efficacy. SETTING: Ambulatory primary care clinic; academic medical center. PARTICIPANTS: Fourteen attending physicians, 12 residents, and 5 nurse practitioners were randomized by clinical team affiliation to a Special Intervention or usual care condition of a larger study. We report the results of the training program for the Special Intervention providers. INTERVENTION: Providers received a 2-hour group training session plus a 10- to 20-minute individual tutorial session 2 to 6 weeks after the group session. The training focused on teaching providers how to perform patient-centered counseling for high-risk and problem drinkers. MAIN OUTCOME MEASURES: Alcohol counseling skills; attitudes regarding preparedness to intervene and perceived importance and usefulness of intervening with high-risk and problem drinkers; and knowledge of the nature, prevalence, and appropriate treatment of alcohol abuse in primary care populations. RESULTS: After training, providers scored significantly higher on measures of counseling skills, preparedness to intervene, perceived usefulness and importance of intervening, and knowledge. CONCLUSION: A group training program plus brief individual feedback can significantly improve primary care providers' counseling skills, attitudes, and knowledge regarding high-risk and problem drinkers.

Alcohol Drinking↗
PubMed1997

Determining and discerning expert practice: a review of the literature.

Although the nature and characteristics of expert practice have been described in the literature, the description is incomplete. How expertise is gained is not fully understood, and definitions of expert competencies have yet to be developed. Essential issues for education arise from the demand for knowledge for expert practice. Because expertise is gained in the context of practice, expertise cannot be achieved out of context or taught as an academic exercise. A clear picture of the practice of expert nurses is necessary so that those in the profession can know and articulate expert practice and direct it to the community.

Clinical Competence↗
PubMed1997

The cardiac nurse's role: an Australian Delphi study perspective.

In Australia, as in many parts of the Western world, technological advances in healthcare have affected the roles of healthcare professionals, including nurses. Cost constraints, efficiency, and effectiveness measures also influence staffing numbers, roles, and skill mix. Specialty nurse education programs are changing, and many are moving from the hospital environment to the higher education sector. Initiatives to introduce the American Advanced Nurse Practitioner role in some environments have begun, although the current advanced practice roles are proving problematic. Specialist professional groups are striving to develop competencies or standards for practice. An understanding of what is required of expert clinicians for practice in complex technological environments such as cardiac care would be useful for both practitioners and academics. A national Delphi study was undertaken to determine what knowledge, skills, and attitudes were required of expert cardiac nurses in relation to technology in the cardiac care environments in both the "real" and the "ideal" worlds of practice. Separate panels of 28 cardiac educators and 42 cardiac nurse clinicians were given a questionnaire of 107 items and asked to indicate on a 6-point Likert scale the importance of each item to the nursing roles in both the "real" and "ideal" worlds. On the final, third round, respondents ranked the three most important items in each of the 13 thematic groups. Overall, the clinicians accepted all 107 items as important to their role, and for the majority of these they, felt that they were performing quite close to their "ideal." This article presents the 32 items for which the clinicians felt the "real" world was quite far from the "ideal" as represented by a gap of > or = 2 between the real and ideal medians. Also, despite being accepted as part of the role through the ideal scores, 21 items achieved a real world median of 3.5 or less, which indicates that in the real world these aspects of nursing are not being valued or practiced to the level clinicians would like. These two sets of items should be of greatest interest to clinicians currently in the role and to those interested in specialty education at all levels.

Australia↗
PubMed1997

Clinical specialty and organizational features of acute hospital wards.

Ward clinical specialty is a variable which has been largely ignored in studies of nursing organization and effectiveness. Analysis of data collected from a nationally representative sample of 83 acute medical, surgical and orthopaedic hospital wards demonstrates that while wards had similar staffing resources, differences exist in the likelihood of adopting a nursing organizational system with devolved authority, in nurses' views of prevailing hierarchical attitudes, and their perceived influence over a range of organizational features of the ward. Medical wards were more likely to have developed organizational practices associated with increasing nursing autonomy.

Analysis of Variance↗
PubMed1997

Pulmonary function in the mechanically ventilated patient.

Implementing the knowledge and skills obtained from the pulmonary function laboratory is useful in the assessment of pulmonary function in the ventilated patient. In the critically ill patient, special constraints and problems (such as safety and ability to cooperate) are important considerations for the therapist performing the testing. Basic measurements such as MIP, VC, VT, MVV, VE, and respiratory rate are commonly made to assess weanability. For the difficult-to-wean patient, WOB, PTP, P0.1 and O2COB may be of potential value in selected patients. Evidence of their value in routine weaning assessment, however, is lacking. Monitoring has evolved with increased understanding of pulmonary mechanics of the mechanically ventilated patient. Measurements of compliance, resistance, MAP, and autoPEEP provide useful diagnostic and therapeutic information, and guide in the selection of appropriate machine settings to provide effective and safe ventilatory support. Although currently confined to the research setting, P-V curves have contributed to our understanding of the pathophysiology of ALI, and may prove useful in defining an optimal ventilatory strategy in patients with ALI. Finally, waveform monitoring can reveal, graphically and in real time, patient-ventilator interactions such as autoPEEP, lung overdistension, patient effort, or the presence of secretions. Waveform monitoring can bring important issues to the close attention of the practitioners involved in management of the ventilated patient.

Critical Care↗
PubMed1996

Cellular analysis of limb development in the mouse mutant hypodactyly.

The limb defect in the mouse Hypodactyly (Hd) affects only the distal structures. Heterozygotes (Hd/+) lack all or part of the distal phalanx and the terminal claw of digit on the hindlimbs; mice homozygous (Hd/Hd) for the mutation have just one digit on each of the four limbs. Early limb development in the mutant appears normal and a change in morphology can only be detected later. Limb buds of Hd/+ and Hd/Hd embryos become reduced in width, with Hd/Hd buds becoming very pointed instead of rounded. This change in bud shape is correlated with an increase in cell death anteriorly in Hd/+ hindlimbs and both anteriorly and posteriorly in Hd/Hd fore- and hindlimb buds. The apical ectodermal ridge is very pronounced in pointed Hd/Hd limb buds. Mesenchyme cells from the Hd/Hd mutant in culture show a cell-autonomous change in behaviour and less cartilage differentiates.

Animals↗
PubMed1996

Household strategies to cope with the economic costs of illness.

The authors examine the strategies rural households in Burkina Faso used to cope with the costs of illness in order to avert negative effects for household production and assets. They use information from 51 qualitative interviews, a household time allocation study and a household survey. Both surveys use the same sample of n = 566 households. The authors analyze these strategies along four dimensions: the type of behavior, the sequence in which strategies employed, the level at which strategies are negotiated, i.e. the household level, the non-household extended kin level or the community level, and finally the success of strategies in protecting household production and assets. A taxonomy of 11 distinct types of coping behavior is developed which have the effect of either avoiding costs by 'ignoring' disease, or of minimizing the impact of costs on the household once illness is perceived. Intra-household labor substitution was the main strategy to compensate for any labor lost to illness. However, labor substitution did not eliminate production losses in the majority of households struck with severe illness of a productive member. Only wealthy household were able to fully compensate labor losses by hiring labor or by investing in equipment to enhance productivity. Sales of livestock was the main strategy to cope with the financial costs of health care. None of the households studied fell into calamity. However, the households' ability to avert the loss of production and/or assets was very varied and depended on household size, composition and assets, on the type and duration of illness and on clustering of crises (e.g. several repetitive or simultaneous illnesses or concurrent seasonal stress). Coping with the costs of illness largely occurred at the level of the household. Inter-household transfers of resources played only a small role. The authors develop the concept of risk households and suggest several policies with the potential to strengthen the ability of households to cope with the economic costs of illness.

Adolescent↗
PubMed1996

The impact of the technological care environment on the nursing role.

Proliferation of acute health care technology creates problems and benefits for nurses and patients. In this paper the impact of technology on the nursing work role is reviewed through the international literature. The thrust of the nursing literature has, not surprisingly, matured over time as the use of technology has become well established in the acute care environment, and three themes can be identified. The implications for acute care nurse specialists, including their educational needs, are set in context of the Australian health care system, with particular reference to the cardiac care environments.

Australia↗
PubMed1996

Enhancement of post trabeculectomy bleb formation by laser suture lysis.

AIMS: To study the efficacy of laser suture lysis in the promotion of filtration and bleb formation during the early postoperative period after trabeculectomy. METHODS: This was a prospective study of 20 eyes from 20 patients undergoing trabeculectomy. Patients were entered into the study if, after a trial period of ocular massage, the intraocular pressure (IOP) was greater than 21 mm Hg 48 hours after surgery. Other criteria for inclusion were a deep quiet anterior chamber, no bleb formation, and a patent internal ostium on gonioscopy. Suture lysis was performed using a frequency doubled neodymium YAG (532 nm) laser and a Hoskins lens. The IOP was measured within 5 minutes of lysis and gentle ocular massage was employed if there was no spontaneous bleb formation. A further suture was lysed if at this stage there was still no bleb associated with a high IOP. RESULTS: Suture lysis was successful in all cases in the early postoperative period. The mean IOP before lysis was 33.8 (SD 8.9) mm Hg and the IOP immediately after lysis was 13.2 (7.9) mm Hg. Eighteen (90%) patients had successfully controlled IOP (mean 14.1 (3.6) mm Hg) without medication after a mean follow up of 6 months. CONCLUSION: Laser suture lysis is a safe and effective method of promoting filtration following trabeculectomy. It can avoid surgical manipulation of the scleral flap with its associated risks of bleb failure and thereby contributes to a successful operative outcome.

Aged↗
PubMed1996

Influence of insulin treatment on the mechanical properties and inotropic response to ethanol in diabetic myocardium.

Diabetes significantly affects cardiac performance, as does ethanol. To assess whether insulin treatment alters the inotropic response to acute ethanol exposure and reverses diabetes-induced myocardial dysfunction, male Wistar rats were made diabetic using streptozocin, 55 mg/kg intravenously. The inotropic effect of ethanol on normal, diabetic, and insulin-treated (8 weeks) diabetic animals was studied using isolated, left-ventricular papillary muscle preparations superfused with Tyrode's solution under isometric conditions. Peak tension developed, time to peak tension (TPT), time to 90% relaxation (RT90), maximum rate of tension developed (+VT), and maximum rate of fall in tension (-VT) were determined in the absence and presence of clinically relevant concentrations of ethanol for 10 minutes. In insulin-treated diabetic muscles, baseline developed tension, +VT, and -VT were enhanced, and the prolongation of TPT and RT90, characteristic of diabetic myocardium, was attenuated. The magnitude of the reduction in developed tension in response to ethanol, 80 mg/dL, was slightly greater in untreated diabetic myocardium. Higher concentrations of ethanol (120 to 240 mg/dL) decreased tension in all groups and was of similar magnitude. The negative inotropic effect of higher ethanol concentrations was associated with shortening of TPT and RT90, as well as a diminution of +VT and -VT. It is concluded that with insulin treatment, the mechanical properties of diabetic myocardium are normalized; however, neither the myocardium's sensitivity to ethanol nor the overall magnitude of ethanol's negative inotropic effect is modified by insulin treatment.

Animals↗
PubMed1995

Development and validation of scales to measure organisational features of acute hospital wards.

In order to make comparisons between wards and explain variations in outcomes of nursing care, there is a growing need in nursing research for reliable and valid measures of the organisational features of acute hospital wards. This research developed The Ward Organisational Features Scales (WOFS); each set of six scales comprising 14 subscales which measure discrete dimensions of acute hospital wards. A study of a nationally representative sample of 825 nurses working in 119 acute wards in 17 hospitals, drawn from seven Regional Health Authorities in England provides evidence for the structure, reliability and validity of this comprehensive set of measures related to: the physical environment of the ward, professional nursing practice, ward leadership, professional working relationships, nurses' influence and job satisfaction. Implications for further research are discussed.

Factor Analysis, Statistical↗