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Biomedical subjects

A Jones

Publications and source records attributed to A Jones.

At least 253 records · Page 14Linked to original sources
PubMed1998

Triploidy: antenatal sonographic features with post-mortem correlation.

A retrospective study was performed comparing the antenatal ultrasound (US) scan features with post-mortem findings in 20 triploid fetuses surviving beyond the first trimester. US scans showed a range of abnormalities including oligohydramnios (60 per cent of cases), intra-uterine growth retardation (IUGR, 55 per cent), central nervous system (CNS) abnormalities (45 per cent), and placental abnormalities (55 per cent). There were obstetric complications in 30 per cent of cases. Post-mortem examinations confirmed these findings but also demonstrated additional anomalies including facial dysmorphism, limb abnormalities (syndactyly, talips equinovarus and thigh muscle hypertrophy), and anomalies of cardio-vascular, respiratory and genito-urinary system. The placenta was normal in 16 per cent of cases, enlarged with cystic change in 47 per cent, small in 32 per cent and infarcted in 5 per cent of cases. Various factors including oligohydramnios, abnormal fetal position, less sophisticated equipment in mid-1980s and relative inexperience of early observers contributed to the reduced sensitivity of US scans in diagnosis of various defects. However, triploidy should be considered in all cases showing early second-trimester IUGR with or without oligohydramnios, a major CNS abnormality and/or an enlarged placenta with or without changes of partial hydatidiform mole. As triploidy is associated with increased obstetric complications, fetal karyotyping should be offered to confirm the diagnosis so that appropriate obstetric intervention can be instituted.

Abnormalities, Multiple↗
PubMed1998

Effectiveness of pediatric practice consultation on missed opportunities for immunization.

OBJECTIVE: To evaluate the effectiveness of pediatric practice consultation in reducing missed-opportunity rates at eight pediatric sites in Baltimore, Maryland. The overarching goal was to decrease the occurrence of missed opportunities from 33% to 15% for the first, second, and third diphtheria and tetanus toxoids and pertussis vaccines during visits at which children were eligible for the vaccines. DESIGN: The effect of an in-office educational program alone at four sites is compared with the educational program and a consultation on office vaccination practices at four matched sites. All eight sites received a small grant ($2,000) to fund practice changes. The medical records of children making visits before and after the interventions were audited to determine missed-opportunity rates. The policies and operations and the knowledge, attitudes, and practices of physicians and nurse practitioners at each site were also assessed. RESULTS: The four education-consultation sites experienced a statistically significant 14% net reduction in the missed-opportunity rate relative to the education-only sites. This positive effect, however, was largely due to an increase in missed opportunities at one education-only site. There was a 10% increase in the missed-opportunity rate among the education-only sites and a 4% decrease among the education-consultation sites; neither change was statistically significant. Two of the three sites that reduced missed opportunities were matched health maintenance organizations (HMOs). Shortly after the interventions, both HMOs implemented tracking and follow-up information systems, which were planned before the interventions. CONCLUSIONS: There is no evidence that either the educational program alone or the educational program and consultation combination reduced missed opportunities. The findings suggest that improved tracking and follow-up data systems and vaccination of children at sick visits may reduce missed opportunities.

Baltimore↗
PubMed1998

The progression and correction of duplex detected velocity shifts in angiographically normal vein grafts.

OBJECTIVES: To review the sensitivity of duplex scanning and angiography at detecting vein graft stenoses in patients on a graft surveillance programme. DESIGN: Prospective, open, non-randomised study. PATIENTS AND METHODS: Since February 1993, 143 patients with 148 grafts (70% in situ, 30% reversed) have attended postoperative infrainguinal vein graft surveillance for a minimum of 6 weeks. Fifty-seven graft stenoses in 57 grafts were identified by duplex scanning as a localised high velocity jet. Angiography was performed in all except 12 patients. RESULTS: Angiography confirmed a duplex abnormality in all but 10 patients. Of these, five patients remain stable and asymptomatic with a persisting duplex abnormality. The remaining five patients, although asymptomatic, exhibited disease progression on duplex and surgical intervention confirmed significant stenoses, which were successfully treated. CONCLUSION: The results suggest that duplex scanning is a reliable imaging modality for detecting vein graft stenoses. Selection for surgical correction can be made, in some circumstances on the basis of clinical and ultrasound criteria alone.

Adult↗
PubMed1998

Host response to EBV infection in X-linked lymphoproliferative disease results from mutations in an SH2-domain encoding gene.

X-linked lymphoproliferative syndrome (XLP or Duncan disease) is characterized by extreme sensitivity to Epstein-Barr virus (EBV), resulting in a complex phenotype manifested by severe or fatal infectious mononucleosis, acquired hypogammaglobulinemia and malignant lymphoma. We have identified a gene, SH2D1A, that is mutated in XLP patients and encodes a novel protein composed of a single SH2 domain. SH2D1A is expressed in many tissues involved in the immune system. The identification of SH2D1A will allow the determination of its mechanism of action as a possible regulator of the EBV-induced immune response.

Antigens, CD↗
PubMed1998

Local anaesthesia for vitreoretinal surgery: a case-control study of 200 cases.

PURPOSE: In the United Kingdom the majority of vitreoretinal (VR) surgery is performed under general anaesthesia (GA). The aim of this study was to demonstrate the scope of local anaesthesia (LA) for VR surgery, to measure the acceptance of LA to patients and surgeons and to compare the surgical outcomes, complication rates and duration of the surgical procedures under LA and GA. METHODS: A case-control study was undertaken to compare 100 cases performed under LA with 100 matched cases performed under GA. The matching of cases was based on multiple criteria such as configuration and complexity of retinal detachment, the involvement of the macula, the number and site of retinal tears, presence and severity of proliferative vitreoretinopathy, experience of the surgeon and the type of the surgical procedure. A clinical audit was also carried out on 65 successive patients using a questionnaire to determine the acceptability of LA to patients and surgeons. RESULTS: Anatomical and visual success rates, and intra-operative and post-operative complications, were similar in cases carried out under LA and GA. The mean duration of the surgery (excluding anaesthetic time) was significantly shorter for LA than GA procedures (p < 0.001). The acceptance for LA was high for both patients and the operating surgeons. CONCLUSIONS: We found that VR surgery can be safely and efficiently performed under LA. Adoption of LA has increased our throughput.

Anesthesia, General↗
PubMed1998

Outcome in patients with a large abdominal aortic aneurysm considered unfit for surgery.

BACKGROUND: The risk of rupture of large abdominal aortic aneurysms (AAAs) remains uncertain. This study aimed to provide data to help decide whether or not to operate on high-risk patients. METHODS: Clinicians were asked to refer all patients with an AAA, even if unfit or elderly. One hundred and ninety-two patients with an intact AAA of 5 cm or greater in diameter were seen in 9 years; 59 had no elective operation and follow-up data were available for 57 at a minimum of 2 years. Initial AAA diameters were 5.0-5-9 cm (n=25) and 6.0 cm or more (n=32). Survival curves were constructed for both groups. RESULTS: At the end of the study 50 of 57 patients had died. Median survival was 18 (range 1-90) months. Twenty (35 per cent) suffered rupture at a median interval of 18 (range 1-38) months. The risk of rupture within 3 years was 28 (95 per cent confidence interval 12-49) per cent for 5.0-5.9-cm AAAs and 41 (24-59) per cent for AAAs of 6 cm or greater. In 133 elective AAA operations in fit patients the 30-day mortality rate was 3 per cent. CONCLUSION: The risk of rupture within 3 years of diagnosis of an AAA of 5 cm or greater exceeds the expected operative mortality rate for fit patients. However, the majority of patients unfit for surgery died from other causes, and only a few would have benefited from aneurysm repair.

Age Factors↗
PubMed1998

Communication about parental illness with children who have learning disabilities and behavioural problems: three case studies.

Parental illness can have a profound impact on family relationships and children's behaviour. The amount and nature of communication between parents and children about the illness can play an important role, both positively and negatively, in mediating the outcomes. When children have a disability, families can be reluctant to communicate with them about family difficulties. They are often concerned about the impact that parental unavailability may have on their child's life. This paper reports on three families in which the mother was diagnosed with breast cancer and one child in the family had a disability. The extent and specific characteristics of their communication about the maternal illness with their children, behavioural changes in the children, explanations of communication strategies and attributions of behavioural changes are described. Family coping strategies are examined with reference to Lazarus's process model of stress and coping and the use of either problem-focused or emotion-focused strategies. Implications for possible clinical interventions are proposed. In particular it is suggested that families be offered consultation about: what children might understand; ways in which to communicate effectively; and strategies for coping with the long-term implications of serious parental illness.

Adolescent↗
PubMed1998

Some reflections on clinical supervision: an existential-phenomenological paradigm.

This paper reviews psychotherapy, counselling, and nursing literature related to ideas of clinical supervision and attempts to illuminate areas important to effective health related practice and specifically palliative care. Included are explorations of existentialism, phenomenology, existential phenomenology and psychoanalytical concepts. The phenomenological idea of lived experience is outlined and the Heideggerian notion of authenticity is explored in context. The paper also examines dynamic forces such as hope, trust and personal values that might influence clinical supervision design and so inform a framework for practice. An existential-phenomenological method of supervision is offered as one basis for professional practice. The central recommendation of this paper is, however, to identify relevant value and belief systems to direct clinical supervision. Nursing models might appropriately instruct approaches to supervision. The writer considers the phenomenological idea of the lived experiences as a means by which to at once capture the essence of palliative care nursing and guide the supervision towards the existential idea of authenticity.

Clinical Competence↗
PubMed1998

Clinical supervision with community Macmillan nurses: some theoretical suppositions and case work reports.

This paper explores clinical supervision undertaken with community Macmillan Clinical Nurse Specialists in the UK. The philosophical motor is embedded in a Heideggerian existential-phenomenological framework, influenced by psychoanalytical thinking as described by Yalom. The discussion is derived from a qualitative research study designed to reach the lived-experience of five Macmillan Clinical Nurse Specialists. The author explores, in context, issues related to authenticity and project. Ideas are linked to contemporary concerns with reflective practice. The recommendation of this paper is that clinical supervision, through whatever method, reaches the vital experience of nursing practice. Realising tacit knowledge has potential to inform professional practice through powerful synergies of theoretical ways, understanding and lived experience. In addition, nurses might attain the existential idea of a boundary experience and so identify constructive ways to address issues arising out of professional practice.

Attitude of Health Personnel↗
PubMed1998

Getting going with clinical supervision: an introductory seminar.

Clinical supervision is an emerging force in nursing practice in the United Kingdom. However, much of the nursing literature suggests uncertainty with regards to what clinical supervision is and the resources needed for safe professional practice. This paper explores a method of introducing clinical supervision to nurses in such a way as to model the skills and competencies required for developing productive working relationships. The main recommendation of this paper is that procedures for introducing clinical supervision mirror qualities required for developing effective nursing relationships.

Education, Nursing, Continuing↗
PubMed1998

'The Awful Rowing toward God': therapeutic conversations with a woman following major surgery.

Listening is a complex event requiring skills and competencies that encompass the personhood of the listener. This paper explores a clinical conversation with a woman experiencing serious illness. The ideas of Klein offer the theoretical means for understanding exchanges. Reflexivity is addressed through exploring the writer's thoughts and feelings in response to significant events. The benefits of supervision, as support and guidance, are discussed in context. The discussion concludes with the suggestion that although many layers of interpretation are possible, and can be informed by various ways of knowing, the act of listening offers potential benefits.

Attitude to Death↗
PubMed1998

'Out of the sighs'--an existential-phenomenological method of clinical supervision: the contribution to palliative care.

This paper describes a method of clinical supervision that engages a Macmillan home care nurse in an existential-phenomenological exchange. A synthesis of Egan's method of problem management and phenomenological interviewing, is offered as an approach to clinical supervision considered appropriate for palliative care nursing. Through a case study approach the author affords glimpses into the life world of palliative care nursing. It is suggested that conflicts experienced in the field both manifest themselves in the supervisory encounter and parallel the nurse's and supervisor's own existential struggles. The discussion as such throws light on what is, frequently, the heart rending nature of palliative care nurses' chosen area of work and illuminates the mutual profundity of the experience of palliative care.

Existentialism↗
PubMed1998

Issues for the development of care pathways in mental health services.

AIMS: This paper seeks to discuss some of the issues for the development of care pathways for inpatients with schizophrenia. BACKGROUND: Managed care pathways are becoming increasingly popular for general adult conditions. Little is known about the development or application of care pathways for mental health services, and in particular, for inpatients diagnosed with schizophrenia. METHODS: Action research principles were adopted to engage and develop support to examine care pathways. Participant observation and unstructured interviews were the primary methods used during this phase of the research. The paper draws on the experiences of one of the authors (AJ) and his attempt to discuss the potential development of a care pathway for in-patients with schizophrenia in one inner city locality in London. FINDINGS: Four central issues were identified by the group; individualized care versus standardized care, generic practice and generic education. CONCLUSIONS: The development and application of care pathways for mental health services requires the consent and commitment from the work force. Many crucial barriers to development arose during the discussion groups and these will require further attention by prospective organizations wishing to apply care pathways to complex diagnostic groups such as schizophrenia.

Adult↗
PubMed1998

Managed mental health care: problems and possibilities.

Case management has become an established organizational approach to mental health care. However, a recent development of case management, known as 'managed care' has received only limited attention in the UK and this has been confined to acute medical or surgical hospital care. The potential of managed care as applied to mental health care is uncertain. This paper clarifies the nature of managed care and discusses its relevance to mental health care, in particular to the care of people suffering from schizophrenia. The high incidence and heavy resource demands of this user group makes these people an ideal focus for managed care. However, there are conceptual and practical problems hindering its development and implementation, including: the variability and unpredictability of the disease process of schizophrenia; challenges of outcome measurement; and problems relating to the current organization of mental health care.

Case Management↗