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Biomedical subjects

A Nightingale

Publications and source records attributed to A Nightingale.

13 recordsLinked to original sources
PubMed2002

Accident and emergency nurses as researchers: exploring some of the ethical issues when researching sensitive topics.

The breadth and complexity of accident and emergency (A&E) services is potentially a fruitful area for nursing and interdisciplinary research. A significant proportion of potential areas for research in A&E settings could be considered as 'sensitive topic areas'. Sensitive topic research raises many challenges; in particular, it raises specific ethical issues. This paper defines and identifies examples of sensitive topic area research in A&E and discusses some of the ethical issues to be considered before embarking on such research in A&E settings.

Emergency Nursing↗
PubMed2001

Antidepressant versus placebo for depressed elderly.

BACKGROUND: Depression warranting intervention is found in ten percent of people over the age of 60. Older depressed people are more likely to die than non-depressed. Relatively few receive therapeutic interventions, and those that do, tend to receive low dose antidepressant therapy. Depression in older people is thought to differ in terms of aetiology, presentation, treatment and outcome than in younger people. Concomitant physical illness and increasing social, physical and neurophysiological diversity are associated with the ageing process. Consequently drug treatment of older patients is often carried out in institutions and on patients suffering from multiple physical problems. OBJECTIVES: To determine the efficacy of antidepressant medication compared with placebo in the treatment of depression in older patients. SEARCH STRATEGY: The search strategy incorporated: electronic literature searches of databases held by the Cochrane Collaboration Depression, Anxiety and Neurosis Review Group (CCDAN) (see Collaborative Review Group Search Strategy). Reference lists of related reviews and references of located studies. Contact was made with authors working in the field. SELECTION CRITERIA: All randomised, placebo controlled trials using antidepressants in the treatment of the presenting episode of depression in patients described as elderly, geriatric senile or older adult. DATA COLLECTION AND ANALYSIS: Two types of data were extracted (if available) from each study. The first type of data was dichotomous data, this consisted of recovered/not recovered. The second, continuous data,included: Hamilton Depression Rating Scale (HAM-D), Montgomery-Asberg Rating Scale (MADRS) and other depression rating scale scores. An analysis using Peto Odds ratios for the dichotomous data and weighted mean difference for continuous data was performed using RevMan 3.1. The presence of heterogeneity of treatment effect was assessed. MAIN RESULTS: Seventeen trials contributed data to the analyses comparing the efficacy of antidepressant treatment and placebo. Analyses of efficacy was based on 245 patients treated with TCAs (223 with placebo), 365 patients treated with SSRIs (372 with placebo) and 58 patients treated with MAOIs (63 with placebo). The standardised effect size for the three groups respectively were: TCAs; OR: 0.32 (0.21,0.47), SSRIs; OR; 0.51 (0.36,0.72), MAOIs: 0.17 (0.07,0.39). REVIEWER'S CONCLUSIONS: TCAs, SSRIs and MAOIs are effective in the treatment of older community patients and inpatients likely to have severe physical illness. At least six weeks of antidepressant treatment is recommended to achieve optimal therapeutic effect. There is little evidence concerning the efficacy of low dose TCA treatment. Further trials are required before low dose TCA treatment is routinely recommended.

Aged↗
PubMed2000

Out-patient psychodynamic psychotherapy services: an analysis of patient discharge data.

OBJECTIVE: To investigate the functioning of a specialist out-patient Psychodynamic Psychotherapy Service by studying demographic characteristics of patient referrals and referral sources. To investigate the effect of number of treatment sessions on outcome; and to discuss the results in the light of some prevailing stereotypes about psychotherapeutic treatment. DESIGN: Analysis of discharge data on a cohort of patients discharged from a psychotherapy clinic. SETTING: An out-patient psychotherapy clinic serving the West Sector of the City of Glasgow. SUBJECTS: All patients discharged between mid 1993 and 1998. RESULTS: The clinic served all General Practices within eight postal code areas in West Glasgow (catchment population 260,000). Over a five year period 1648 patients were discharged from the clinic; 68% of referrals were from General Practitioners, 18% from Psychiatrists and the remainder from Clinical Psychologists, Consultant Physicians and Surgeons. A wide range of diagnostic conditions were encountered with personality disorder being diagnosed in more than one-third of patients seen. Successful outcome, assessed by patients' subjective ratings on a four point scale at termination of treatment, showed a 50% improvement rate achieved between 7-12 treatment sessions in the Non Personality Disorder group, and between 12-20 treatment sessions in the Personality Disorder group. In total the proportion of not improved and improved ratings was 61% and 39% respectively. Four hundred (73%) of the not improved group received, five sessions or less. CONCLUSIONS: The results indicated that the Psychotherapy Service treated a large number of patients, many from middle to high areas of deprivation, and that improvement could be effected over relatively short time periods. The data did not conform to existing stereotypes such as psychotherapy being confined to the treatment of "worried well", affluent groups. It took twice as many sessions to achieve a 50% improvement rate in patients with a diagnosis of personality disorder compared with patients without such a diagnosis.

Adult↗
PubMed1999

The monitoring of contaminated impervious planar surfaces.

The responses of several types of surface contamination monitor have been investigated for three typical working surfaces contaminated by three radionuclides commonly used in diagnostic or analytical biomedical applications. Of the three radionuclides, 99mTc is an intermediate-energy gamma emitter, 125I decays by electron capture, emitting low-energy x-rays, and 32P is a moderate-energy beta emitter. For each radionuclide monitored values have generally been found to be within 30% of projected response, this being based on calibrations which make use of standard radionuclide sources and conditions. The several types of contaminated non-absorbent surface that have been investigated produce monitored values which for a given type of monitor and radionuclide cannot be differentiated from each other.

Equipment Contamination↗
PubMed1997

Radiation dose and in vitro precision in paediatric bone mineral density measurement using dual X-ray absorptiometry.

Dual X-ray absorptiometry (DXA) is one of the most widely used techniques for non-invasive assessment of bone integrity. There is a growing demand for measurement of paediatric bone status. In DXA the principal radiation risks to patients are the carcinogenic and genetic effects. Radiation dosimetry is well established for DXA in adults, but there are limited paediatric data available. We report on a study to estimate the effective doses (EDs) received by typical 5- and 10-year-old children using the paediatric scan mode on the Lunar DPX-L bone mineral density scanner. Entrance surface doses (ESDs) and percentage depth doses for the total body and PA spine scan modes were measured using lithium borate thermoluminescent dosemeters (TLDs) located at the surface and distributed at various organ locations in anthropomorphic child phantoms. The EDs were calculated from the percentage depth doses, amount of each organ irradiated and tissue weighting factors. The ESDs were measured to be 6.0 and 0.12 microGy for the posteroanterior (PA) spine and total body, respectively. PA spine EDs were calculated as 0.28 and 0.20 microSv for the 5- and 10-year-old, respectively. Total body EDs were 0.03 and 0.02 microSv for the 5- and 10-year-old children, respectively. These results compare with an adult ED of 0.21 microSv for the PA spine. They are also more than two orders of magnitude lower than reported ESDs and EDs for paediatric chest X-rays. Bone mineral density (BMD) short-term in vitro precision was 0.5% and 1% in the 5- and 10-year-old phantoms, respectively. In conclusion, the Lunar DPX-L in the paediatric mode has a high precision and very low radiation doses, similar to those reported for the adult mode.

Absorptiometry, Photon↗
PubMed1989

Quality of outcome and cost in an obstetric and neonatal service.

A review has been made of the outcome and efficiency of the obstetric and neonatal service, St Helen's Hospital, Auckland. In the last seven years there has been a 33% fall in perinatal mortality rates to 5.88 per 1000 births in 1987. The average perinatal death rate for Maori infants was low, 4.81 per 1000 compared to 7.43 per 1000 for Europeans over this period. There has been a 38% increase in births to 3597 a year while the total hospital staffing has only risen 9%. Thus the ratio of births to staff has increased by 26.6% to 15.6. The cost per infant delivered in constant dollars has fallen 18.7% in the same period to $2432. The postnatal bed occupancy was 101% in 1987 and the average day stay fell to 5.7 days. An extra 61 full time staff would be needed to reduce the workload to that of 1981 and the staff is now unable to give the family focused holistic care that is needed.

Costs and Cost Analysis↗
PubMed1984

Serous effusions in monocytic leukaemias.

We report four patients who either presented with or developed serous effusions during the course of monocytic leukaemia. This finding has not been documented previously. All the patients had very high peripheral blood monocyte counts when effusions developed. The effusions resolved after the patients were treated with anti-leukaemic therapy. It is therefore likely that the effusions were disease related. Two of the patients have been treated with razoxane, one with etoposide and the other with cytarabine.

Aged↗