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Biomedical subjects

A Mitchell

Publications and source records attributed to A Mitchell.

324 records · Page 18Linked to original sources
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Burn out. Cooling down.

Explore the source record for details and available documents.

Burnout, Professional↗
PubMedDate not supplied

Developing and testing a self medication protocol in the acute environment.

This study aimed to develop and test strategies, and demonstrate the feasibility and desirability of a self-medication program in an acute care hospital setting. Ten patients admitted with an acute exacerbation of their asthma were recruited to test the protocol. Although the use of the protocol was more time-consuming than the previous nurse administered process, patients and staff found it worthwhile. The outcome of the study is a protocol that could be used with a larger sample of patients, in the acute environment.

Acute Disease↗
PubMedDate not supplied

Quality of life after use of the patient activated atrial defibrillator.

The aim of the study was to evaluate the effects of long-term use of the patient-activated atrial defibrillator for recurrent persistent atrial fibrillation (AF) on quality of life (QOL). Fifteen patients were implanted with the Medtronic Jewel AF 7250 device (dual chamber atrial and ventricular defibrillator) for AF only. AF recurrences were treated by out-of-hospital patient-activated atrial defibrillation shocks following the self-administration of oral sedation. QOL was assessed at pre-implant and up to one year with SF36, symptom checklist and HADS questionnaires. A total of 238 (median 10) out-of-hospital patient-activated atrial defibrillation shocks were performed. The SF36 demonstrated a trend toward improvement over the 12-month period compared with baseline values. There was no significant change in the symptom frequency or severity scores. Pre-implant levels of both anxiety and depression were within the predefined range of normality (6 +/- 3 and 3 +/- 2, respectively) and no significant change was seen at 6 months (5 +/- 4 and 3 +/- 3) or 12 months post implant (5 +/- 4 and 2 +/- 2, respectively). After one year of follow-up, 13 (87%) patients said they would have the device implanted again (two were undecided). The study demonstrates that patient-activated atrial defibrillation is a well tolerated therapeutic strategy for maintaining sinus rhythm.

Adult↗
PubMedDate not supplied

Normal levels of lipoproteins including lipoprotein(a) after liver-heart transplantation in a patient with homozygous familial hypercholesterolaemia.

A 33-year-old female with severe diffuse coronary artery disease and left ventricular outflow tract obstruction secondary to homozygous familial hypercholesterolaemia underwent liver and heart transplantation. During a post-operative follow-up period of 13 months, apart from one episode of cardiac rejection at 3 weeks, she has remained well and without evidence of accelerated coronary disease on angiography. By 3 months after transplantation serum total cholesterol, low density lipoprotein cholesterol, apolipoprotein B and lipoprotein(a) levels had decreased and apolipoprotein A-I and high density lipoprotein cholesterol levels had increased, all to within the normal range. These changes were accompanied by marked regression of xanthomata and were maintained at 13 months. Liver transplantation provides an effective means of correcting serum lipids in patients with homozygous familial hypercholesterolaemia and is an important adjunct to cardiac transplantation.

Adult↗
PubMedDate not supplied

Bias in the design of studies which examine genetic and environmental influences on behaviour.

Genetic and environmental factors may interact to influence the development of complex disorders such as schizophrenia, depression and alcoholism. Twin and adoption studies are used to examine the relative influence of these factors on such behaviours. We propose a set of guidelines for critiquing these studies. Results of the methodologically sound studies may be useful in identifying high risk populations and designing and implementing prevention and treatment programs.

Adoption↗
PubMedDate not supplied

Advice over the telephone.

The authors of this paper anonymously telephoned A&E departments in the Thames area that provided 24-hour emergency cover to investigate the safety and validity of medical advice given by these departments over the telephone to the public.

Counseling↗
PubMedDate not supplied

Comparison of liaison and staff nurses in discharge referrals of postpartum patients for public health nursing follow-up.

The purpose of this study was to compare hospital staff nurses to public health liaison nurses in the accuracy and cost of postpartum referrals for public health nursing follow-up in the community. In the before phase of the study, public health liaison nurses assessed 304 mothers to determine the need for a follow-up visit by the public health nurse. In the after phase, staff nurses assessed 326 mothers. Public health nurses, unaware of the identity of the referring nurse and the referral decision, judged whether their visit had been required. Staff nurses correctly identified a higher proportion of referrals requiring public health nurse follow-up than liaison nurses. Although they referred more clients who did not require a public health nurse visit, costs of referrals by staff nurses remained lower.

Adult↗
PubMedDate not supplied

Changing nursing practice--trisectoral collaboration in decision making.

In an age of cost containment, agency partnerships have become an essential element for future planning and program implementation. This paper describes a trisectoral collaboration of a hospital, health department, university and school of nursing to compare the efficacy and efficiency of referral decisions of hospital staff nurses to those of the public health liaison nurses (LNs). A process to identify decision criteria was undertaken and an educational programme was designed to assist the staff nurses with the referral process and to assure consistency of decision making. The two groups were then compared. The results of the study found staff nurses, using the decision criteria, identified more patients who required public health nursing visits than did the liaison nurses, refusal rate of the patients to participate was no different, staff nurses cost less than LNs and job satisfaction was not significantly altered for either group. In addition to providing information to guide administrative and clinical decision making, the project also provided a learning experience for the staff of three agencies in conducting research and in using evidence-based practice to change traditional practice.

Decision Making, Organizational↗
PubMedDate not supplied

A systematic overview of the effectiveness of home visiting as a delivery strategy for public health nursing interventions.

The purpose of this systematic overview was to assess the evidence for the effectiveness of public health nursing interventions when carried out by the strategy of home visiting. A search of published and unpublished literature resulted in retrieval of 108 articles; 77 articles were judged to be relevant. Validity criteria included method of allocation to the study groups, level of agreement to participate in the study, control for confounders, method of data collection (pretesting of data collection tools, blinding of data collectors to group allocation of study participants), quantitative measure of effect and percentage of participants available at follow-up. Using these criteria, 9 articles were judged to be strong, 5 moderate and 63 weak. There were no reported negative effects of home visiting in the 9 strong articles. Positive outcomes included improvement in children's mental development, mental health and physical growth; reduction in mother's anxiety, depression, and tobacco use; improvement in maternal employment, nutrition and other health habits; government cost saving; and reduced level of care required for the elderly.

Canada↗