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Biomedical subjects

A Street

Publications and source records attributed to A Street.

At least 37 records · Page 2Linked to original sources
PubMed2001

Improving patient recruitment to multicentre clinical trials: the case for employing a data manager in a district general hospital-based oncology centre.

One of the most frequently cited reasons for poor recruitment to multicentre randomized clinical trials is the additional workload placed on clinical staff. We report the effect on patient recruitment of employing a data manager to support clinical staff in an English district general hospital (DGH). In addition, we explore the effect data managers have on the quality of data collected, proxied by the number of queries arising with the trial organizers. We estimate that the cost of employing a data manager on a full-time basis is 502 per patient recruited but may amount to 326 if the appointment is part-time. Data quality is high when full responsibility lies with a data manager but falls when responsibility is shared. Whether the costs of employing a data manager to recruit patients from a DGH are worth incurring depends on the value placed on the speed at which multicentre trials can be completed, how important it is to broaden the research base beyond the traditional setting of teaching hospitals, and the amount of evaluative data required.

Clinical Trials as Topic↗
PubMed2001

Health system goals: life, death and ... football.

OBJECTIVES: Both the World Health Organization (WHO) and the Fédération Internationale de Football Association (FIFA) have developed sophisticated ways of defining and aggregating performance to produce overall, single-number indices. These are used to illustrate some of the problems of measuring, comparing and improving health system performance. METHODS: Possible associations between FIFA football rankings for international 'A' sides for 176 countries and rankings on the WHO overall health system performance index were explored using econometric techniques. RESULTS: There is a significant relationship between a country's FIFA ranking and its ranking by the WHO. Taken at face value, the statistical analysis suggests that, if the national football team does well, the WHO score improves. CONCLUSIONS: The relationship between FIFA and WHO ranks is entirely spurious. However, comparison of the two indices illustrates problems with the WHO exercise, including measurement difficulties, how policy-makers may use the information to improve health system performance, what the public are to make of the data and how different dimensions of overall performance may be subject to trade-offs.

Delivery of Health Care↗
PubMed2001

The role of the palliative care nurse consultant in promoting continuity of end-of-life care.

The provision of end-of-life care through a multidisciplinary integrated palliative-care approach is dependent on effective communication between professional groups and services. We did a qualitative study, using semi-structured individual and focus group interviews, in Melbourne, Australia. The research aim was to explore the experiences and strategies used by palliative care nurses to communicate with general practitioners. We found that palliative care nurse consultants in acute hospitals not only provided inpatient consultation, but also played an important part in facilitating continuity of care across healthcare services by improving existing communication strategies and establishing further communication networks. However, there were several issues that had the potential to disrupt communication, and this article reports on the role of the palliative care nurse consultant in addressing these issues.

Community Health Nursing↗
PubMed2000

Legitimation of nurses' knowledge through policies and protocols in clinical practice.

Health care professionals use policies and protocols in varying ways to guide their clinical activities and to promote quality patient care. The critical ethnographic case study upon which this paper is based, involved a research group comprising six registered nurses who worked in a critical care setting. Research methods included professional journalling, participant observation, and focus group and individual interviews. This paper examines the power relations at play between doctors and nurses, and among nurses, and the ways in which nurses used policies and protocols as a means of mediating communication. While policies and protocols provided nurses with legitimacy of their knowledge in the clinical arena, doctors tended to rely on their past experience and background to inform their knowledge and activities. For nurses to believe that they provided valued and collaborative input in patient decisions, they actively sought out written evidence through policies and protocols to confirm and support their knowledge. Policies and protocols of critical care activities provided nurses with expected standards of care, which they used to legitimize their knowledge and to communicate with doctors about 'undesirable' medical decisions. The doctors valued their professional authority and autonomy over policies and protocols, while nurses used these written guidelines to assert power and demonstrate resistance. Policies and protocols do not exist in isolation; they occur within a complex network of power relations that create tensions in clinical practice. In challenging these tensions, it is important that nurses and doctors establish a fine balance between using policies and protocols to provide directions for practice, and to allow sufficient latitude and flexibility in addressing the complexities of patient care.

Clinical Protocols↗
PubMed2000

Possibilities for critical social theory and Foucault's work: a toolbox approach.

The benefits and constraints of philosophical frameworks using the work of Michel Foucault and critical social theorists, such as Fay, Giroux and McLaren, are examined in the light of their traditions. The reasons nurse researchers adopt these frameworks are explored, as are the tensions between the respective theories. A complementary 'toolbox' approach to the research process addresses some of the theoretical and methodological challenges presented by each framework. Such an approach provides distinctive insights into nursing practice that the other has ignored or missed. It is argued that by converging the two frameworks into a toolbox approach, it is possible to examine or deconstruct existing practices, whilst also providing an avenue for nurses to reconstruct or change such practices.

Humans↗
PubMed2000

The handover: uncovering the hidden practices of nurses.

This paper considers the ways in which the nursing handover involves a complex network of communication that impacts on nursing interactions. The critical ethnographic study upon which this paper is based involved a research group of six nurses who worked in one critical care unit. Data-collection methods involved professional journalling, participant observation, and individual and focus group interviews. The nursing handover took on many forms and served different purposes. At the start of a shift, the nurse coordinator of the previous shift presented a 'global' handover of all patients to oncoming nurses. Nurses proceeded then to the bedside handover, where the intention changed from one that involved a broad overview of patients, to one that concentrated on a patient's individual needs. Data analysis identified five practices for consideration: the global handover serving the needs of nurse coordinators; the examination; the tyranny of tidiness; the tyranny of busyness; and the need to create a sense of finality. In challenging nurses' understanding of these practices, they can become more sensitive to other nurses' needs, thus promoting the handover process as a site for collaborative and supportive communication.

Anthropology, Cultural↗
PubMed2000

Experience with continuous infusion of recombinant activated factor VII in the Asia-Pacific region.

There is increasing interest in continuous infusion of recombinant activated factor VII (rFVIIa) as a convenient and safe alternative to intermittent bolus therapy. In the Australian patients reported in this paper, cost savings of up to 25% in the first 12 h of treatment with continuous infusion of rFVIIa have been achieved safely, suggesting that substantial overall savings are possible. However, in the Thai patient reported, a dose reduction of 35% in the first 12 h was associated with poor haemostatic control, suggesting that a dose reduction of >25% may be inadvisable. The indications for treatment in the five Australian patients were: retroperitoneal haemorrhage (n = 3); right forearm compartment syndrome (n = 1); wrist haemarthrosis and median nerve compression (n = 2); sublingual haematoma (n = 1); and cerebral (mid-brain) haemorrhage (n = 1). Treatment was effective in four out of five patients (six bleeding episodes) and there was one treatment failure where treatment had been substantially delayed. The Thai patient was treated as part of a prospective, uncontrolled, observational study of 34 bleeding episodes in 22 patients in the Asia-Pacific region. Treatment was judged ineffective after 24 h, but full haemostatic control was subsequently achieved with intermittent rFVIIa therapy.

Adult↗
PubMed2000

A revised model of platelet aggregation.

In this study we have examined the mechanism of platelet aggregation under physiological flow conditions using an in vitro flow-based platelet aggregation assay and an in vivo rat thrombosis model. Our studies demonstrate an unexpected complexity to the platelet aggregation process in which platelets in flowing blood continuously tether, translocate, and/or detach from the luminal surface of a growing platelet thrombus at both arterial and venous shear rates. Studies of platelets congenitally deficient in von Willebrand factor (vWf) or integrin alpha(IIb)beta(3) demonstrated a key role for platelet vWf in mediating platelet tethering and translocation, whereas integrin alpha(IIb)beta(3) mediated cell arrest. Platelet aggregation under flow appears to be a multistep process involving: (a) exposure of vWf on the surface of immobilized platelets; (b) a reversible phase of platelet aggregation mediated by the binding of GPIbalpha on the surface of free-flowing platelets to vWf on the surface of immobilized platelets; and (c) an irreversible phase of aggregation dependent on integrin alpha(IIb)beta(3). Studies of platelet thrombus formation in vivo demonstrate that this multistep adhesion mechanism is indispensable for platelet aggregation in arterioles and also appears to promote platelet aggregate formation in venules. Together, our studies demonstrate an important role for platelet vWf in initiating the platelet aggregation process under flow and challenge the currently accepted view that the vWf-GPIbalpha interaction is exclusively involved in initiating platelet aggregation at elevated shear rates.

Animals↗
PubMed2000

Nurses of NESB working in a multicultural community.

Ensuring that the cultural composition of the nursing population reflects the multicultural mix of the general population assumes that culturally appropriate care will occur when people of non-English background (NESB) are encountered in nursing practice. In a feminist praxis study involving twenty-six nurse participants, seven of whom were of NESB, the nurses discovered that the structure of the health care institution not only overlooked the cultural and linguistic needs of children and NESB families, but also created a dominant Anglo-Australian health culture that taught NESB nurses to ignore the traditions and practices of their NESB culture. This paper will explore the nurses' discovery of their own collusion in sustaining an Anglo-Australian health care culture.

Australia↗
PubMed1999

The economic consequences of reorganizing hospital services in Bishkek, Kyrgyzstan.

Kyrgyzstan gained independence from the Soviet Union in 1991 and has since been thrown into severe financial crisis. All public sector funding has been significantly reduced and international aid agencies are supporting the government in rebuilding the economy. The health sector requires a radical overhaul and a major part of this process involves rationalization of existing facilities, particularly in the capital Bishkek, where 26 secondary and tertiary hospitals support a population of approximately 800000 people. This paper describes the development of a plan for rationalization with particular emphasis on the economic aspects of the process. This involved calculating future hospital requirements by modelling a variety of policy options, ranging from changes to clinical practice to hospital closures. The model generates estimates of resource requirements at each hospital, from which the costs falling on the health budget and patients are derived.

Adult↗
PubMed1999

Discharge planning and transitional care: issues in Thai nursing.

Discharge planning is part of the care process that places nurses in a pivotal position in facilitating continuity of care for clients. This ethnographic study explored the current discharge practices of Thai nurses and examined how transitions from hospital to home were incorporated into Thai nursing practice. The study was conducted with registered nurses in an acute hospital in central Thailand. Results indicated that the discharge process in this community was highly informal with several factors affecting the effectiveness of nurses' discharge functions. Consequently, strategies to improve this care process were proposed for further implementation.

Anthropology, Cultural↗
PubMed1999

Cost-sharing and pharmaceutical utilisation and expenditure in Russia.

This paper presents estimates of the impact of exemption status, and other socio-economic variables, on pharmaceutical use in Russia. Estimates are derived from a newly collected household survey covering around four thousand households. Separate results for a zero-inflated negbin model of utilisation of prescriptions and for a two-part model of the overall level of household expenditure on pharmaceuticals are presented. Full exemption from prescription charges is shown to increase the utilisation of prescription items and reduce the probability of the households incurring drug expenditure.

Cost Sharing↗
PubMed1999

Problem-based learning: an educational strategy to support nurses working in a multicultural community.

Physical dislocation of people from their homelands either as refugees, immigrants or exiles has resulted in the creation of multicultural communities which have diverse health needs. Like elsewhere, nurses in Australia have been faced with the challenge of responding to an ever-changing migrant population. A modified problem-based learning project was conducted in Melbourne to assist nurses to enhance their practice of caring for children and families of non-English speaking backgrounds (NESB). Clinical nurses worked with the researchers to develop and trial problem-based educational packages. The packages were designed for use in the clinical areas and graduate nursing programs to assist nurses overcome the cultural and communication difficulties they experienced when caring for people of NESB.

Australia↗