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Biomedical subjects

A J Tierney

Publications and source records attributed to A J Tierney.

At least 37 records · Page 2Linked to original sources
PubMed1994

Measuring the costs and quality of palliative care: a discussion paper.

In an era of ever increasing emphasis on cost-effectiveness of health care, and with the introduction of the internal market, there is now an urgent need for information on the costs and quality of palliative care. This paper highlights the complexities involved in acquiring and measuring such information and discusses methods which were tried out in an exploratory study. The study took the form of in-depth case studies in two hospices, one in the voluntary sector and one in the NHS.

Consumer Behavior↗
PubMed1993

Conducting research interviews with elderly people by telephone.

Telephone interviews were employed by nurse researchers as a means of collecting data from elderly people following their discharge from hospital. The paper reviews the literature concerning interviews with elderly patients by telephone and recounts first-hand experience of the method on the basis of over 500 telephone interviews. Although some difficulties were encountered in conducting interviews with the hearing-impaired and the unwell, the method was found to be a cost-effective and useful means of obtaining follow-up data for research purposes. The prime factor in ensuring successful use of the method was the recruitment of subjects via personal interview prior to telephone contact.

Aged↗
PubMed1993

The complexities of using a structure, process and outcome framework: the case of an evaluation of discharge planning for elderly patients.

Effective planning for discharge from hospital of elderly patients is becoming increasingly important as the elderly population rises. Donabedian's structure-process-outcome framework was used for an evaluation of discharge planning at a large teaching hospital. This paper discusses first the difficulties of defining the boundaries between each of the three Donabedian categories, and then makes some suggestions as to what factors require inclusion when considering the structures, processes and outcomes of discharge planning for elderly patients.

Aged↗
PubMed1993

Challenges for nursing research in an era dominated by health service reform and cost containment.

Many health care systems around the world are under reform, not least for reason of necessary cost containment. As one of the largest items of a health service budget, the costs of nursing services are attracting particular attention. This behooves the nursing profession, if only in its own interest, to accumulate convincing evidence of the cost-effectiveness of nursing. Nursing's research track record in the assessment of the costs, quality, and effectiveness of nursing is assessed in this paper and found to be generally weak. The complexity of such research is acknowledged; the need for research which will insure and demonstrate the highest quality of nursing at the lowest possible cost is presented as a key challenge for nurse researchers in the present era.

Cost Control↗
PubMed1992

Neonatal congenital diaphragmatic hernia and extracorporeal membrane oxygenation.

OBJECTIVE: To describe the outcome of infants with congenital diaphragmatic hernia (CDH) presenting early who were referred for possible extracorporeal membrane oxygenation (ECMO). DESIGN: Retrospective descriptive study. SETTING: Neonatal Intensive Care Unit of the Royal Alexandra Hospital, Edmonton. PATIENTS: Fifteen infants referred to our program since its introduction, in February 1989; 13 received ECMO. The criterion for ECMO was the presence of an oxygen index of more than 40 on three occasions within 2 hours. INTERVENTION: ECMO was performed by means of cannulation of the right carotid artery and jugular vein for 111.0 hours on average. RESULTS: In 5 of the 13 infants who underwent ECMO the procedure was performed after surgical repair; all were successfully weaned off ECMO, and the cannula was removed without incident. In the remaining eight ECMO was started before surgical repair; of the six who received it during repair four ultimately survived. None of the previously described predictors of outcome for CDH, including diagnosis before 25 weeks' gestation (in six cases), were useful in determining the survival of the patients. Bleeding was the most common complication and cause of death. CONCLUSION: ECMO is associated with survival in infants with CDH who fail to respond to conventional therapy and who have a poor prognosis according to previously established criteria.

Extracorporeal Membrane Oxygenation↗
PubMed1992

A rare intrapericardial mass in a neonate.

We describe a rare case of a neonate born with an intrapericardial mass composed of extralobar pulmonary sequestration and a cyst of bronchogenic origin. After an uneventful delivery, this full-term newborn was noted to be grunting and indrawing. He remained tachypneic despite adequate management for bilateral pneumothoraces. Diagnostic studies showed a 3 x 3 x 4 cm diameter cystic lesion in the anterior mediastinum causing posterior-lateral displacement of the superior vena cava. The heart itself was structurally normal. Bronchoscopy and esophagoscopy failed to detect any structural abnormalities. At 3 weeks of age, sternotomy and resection of the lesion was performed. The mass was clearly intrapericardial and consisted of sequestrated pulmonary tissue with a unilocular mucus filled bronchogenic cyst. Small systemic tributaries fed the lesion from the posterior-superior aspect. There was no connection with the heart or great vessels. Postoperative recovery was uneventful.

Bronchi↗
PubMed1992

Knowledge, expectations and experiences of patients receiving chemotherapy for breast cancer.

The experiences of a cohort of 60 women receiving chemotherapy in treatment of breast cancer were monitored in an in-depth prospective study. The purpose of the investigation was to identify ways in which nurses could improve the preparation and support of patients undergoing chemotherapy. It was found that patients' knowledge of chemotherapy was limited and that the side-effects they experienced, and their reactions to these, were rather different and more diverse than had been expected. The study illustrates the value of exploring patients' perceptions of their problems and needs for information and support.

Adult↗
PubMed1992

Physiological role of the transient potassium current in the pyloric circuit of the lobster stomatogastric ganglion.

1. Our experiments were performed to assess the quantitative role of the transient potassium current, IA, in determining the cycle frequency and phasing of neurons in the network generating the pyloric motor rhythm in the stomatogastric ganglion of the spiny lobster, Panulirus interruptus. We used 4-aminopyridine (4-AP) to reduce IA and recorded the effects of this treatment on cell activity. 2. In the intact circuit with an actively cycling pyloric rhythm, 4-AP had three major effects on the rhythm. First, the cycle period was decreased approximately 20%. Second, 4-AP enhanced the activity of all cells, causing increases in spikes/burst and spike frequency within bursts. Third, 4-AP altered the phasing of follower cells relative to the onset of the pacemaker (AB/PD) bursts. The lateral pyloric (LP) and pylorics (PYs) were phase advanced by 4-AP, whereas the ventral dilator (VD) was phase delayed. 3. Voltage-clamp studies indicated that pyloric cells differed in the amount of IA they expressed on or near the soma. IA was largest in pyloric dilator (PD) and PY cells, smaller in the anterior burster (AB), LP, and inferior cardiac (IC) cells, and undetectable in the VD cell. When cells were isolated from synaptic input, however, all were excited by 4-AP, suggesting that all possess functionally significant IA. In VD cells, IA-like currents probably occur primarily in nonsomatic cell regions. 4. We measured postinhibitory rebound by determining the delay to the first spike after a series of 200-ms hyperpolarizing prepulses in the PD, PY, LP, VD, and IC cells. In all five cell types, the delay was progressively increased as the potential of the hyperpolarizing prepulse became more negative. This increased delay reflected the removal of IA inactivation. The delay was greatest in the PY cell and least in the IC. In four cells (the PD, PY, LP, and VD) 4-AP decreased the delay to the first spike at all prepulse potentials. In the IC the delay to the first spike was unaffected by 4-AP, suggesting that IA was not responsible for the relatively short delay after hyperpolarizing prepulses. 5. In all five cell types, 4-AP increased the spike frequency for the duration of a 1-s depolarization. The 4-AP-sensitive current responsible for this behavior appears to have very rapid kinetics and may represent a distinct channel subtype. Functionally, this current may act to dampen cell excitability and to reduce spike frequency during bursts.

4-Aminopyridine↗
PubMed1991

Research in practice: an 'experiment' in researcher-practitioner collaboration.

There are signs that researchers and practitioners are seriously attempting to work more closely together to bring research and practice into closer alliance. This paper describes one such attempt in the form of an 'experiment' in collaboration between academic researchers and practising nurses in the undertaking of a practice-based research project. Positive benefits of collaborative research became evident and are highlighted in this paper. No attempt was made to evaluate the 'experiment' objectively and so this is a subjective account, aimed at encouraging other efforts towards closer collaboration between researchers and practitioners in nursing.

Alopecia↗
PubMed1990

Theatre gowns: a survey of the extent of user protection.

This paper describes a survey of contamination by blood and other body fluids to theatre staff during general and orthopaedic surgery. Fourteen surgeons completed questionnaires following 243 operations, providing information describing the extent of contamination. Recommendations are made for more extensive precautions to be taken when operating on patients considered to be at high-risk of carrying human immunodeficiency virus (HIV). Further assessment of the reliability and comfort of impermeable gowns is required.

Blood↗
PubMed1990

HIV infection, AIDS and community nursing staff in Scotland.

Little is known about the effects of the 'AIDS epidemic' on the work of community nursing staff. In order to ascertain the extent and nature of their work related to HIV infection and AIDS, and to assess their knowledge and beliefs, a postal survey of one in five community nursing staff in Scotland was carried out. A response rate of 85% was achieved. While only 3% of respondents had encountered a patient with AIDS, 11% had been involved with HIV antibody positive patients and 30% had encountered professionally others worried about or at high risk of infection. Findings show that, although community nursing staff consider they have a role to play in health education, counselling and terminal care, they largely feel lacking in confidence and ill-prepared for this role. Recommendations are made for improvements in education, and in the provision of information and policy, geared specifically to the roles of different types of community nursing staff in their day-to-day work.

Acquired Immunodeficiency Syndrome↗
PubMed1988

The dose response of theophylline in the treatment of apnea of prematurity.

In an effort to establish the minimum effective dose of theophylline in the treatment of idiopathic apnea of prematurity, a prospective trial of 22 infants with at least 0.33 episodes of apnea per hour were studied. Apnea was diagnosed exclusively by continuous recording of heart rate, respiratory impedance, end-tidal CO2, and either or both transcutaneous oxygen and pulse oximetry. Four discrete serum concentrations of theophylline (23 mumol/l or 4.2 mg/L, 47 mumol/L or 8.5 mg/L, 70 mumol/L or 12.7 mg/L, and 84 mumol/L or 15.3 mg/L) were attained by using repeated loading doses of 4 mg/kg and increasing the maintenance dose from 1 to 1.5 mg/kg to 2 to 2.5 mg/kg, given every 8 hours. Before treatment and 24 hours after each loading dose, airway occlusions and measures of tidal volume, minute ventilation, and respiratory timing were performed. The effectiveness of therapy was assessed by either a continuous computer data-acquisition system or paper recording for the duration of the study. Of the 22 infants, three responded at level 1, three at level 2, and 10 at level 3. One of the four infants loaded to the fourth level had a sustained response for a total cumulative response of 77%. The five remaining infants required additional treatment with doxapram or continuous positive airway pressure. There was a significant increase in inspiratory pressure 100 msec after airway occlusion, maximum inspiratory pressure during airway occlusion, tidal volume, ratio of tidal volume to inspiratory time (mean inspiratory flow), and minute ventilation from the pretreatment measurements to those at the maximum dose of theophylline. The apnea response did not correlate with these improvements in ventilation measures.

Apnea↗
PubMed1988

Neonatal apnea: diagnosis by nurse versus computer.

In an effort to characterize significant neonatal apnea and evaluate the nursing diagnosis of apnea, apnea type and frequency were determined in 27 infants by continuous computer recording of heart rate, respiratory impedance, end-tidal CO2, and either or both transcutaneous oxygen and pulse oximetry. Of the 1,266 recorded apneas, 46% were central, 44% were mixed, and 10% were obstructive. Mixed apnea was associated with a longer mean duration and greater mean decrease in heart rate than central apnea. Apnea duration was positively correlated with both a decrease in heart rate and oxygen saturation (P less than .001), and a lower baseline saturation was associated with a greater decrease in oxygen saturation during apnea (P = .002). Theophylline therapy had no effect on apnea duration or oxygen desaturation but resulted in a decrease in the mean heart rate decrease associated with apnea. Overall, nurses diagnosed 54% of all apneic episodes and were significantly poorer at detecting mixed and obstructive events. Nursing detection of apnea improved with increasing apnea duration and was always associated with a greater decrease in heart rate. Nurses diagnosed significantly fewer mixed apnea following theophylline therapy. Improved monitoring techniques, particularly for mixed and obstructive apnea, are essential to increase apnea detection in the nursery.

Apnea↗