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Biomedical subjects

B McCormack

Publications and source records attributed to B McCormack.

At least 19 recordsLinked to original sources
PubMed2000

Creating an adult learning culture through practice development.

The development of a learning culture is becoming a dominant theme in the strategic plans of health care organisations. This is arising through a drive to improve standards of practice, bridge the perceived theory-practice gap and create means of integrating learning with practice. There have been many initiatives to create such a change, including continuous professional development, reflective practice, clinical supervision and work based learning. This paper presents an account of a practice development strategy that aimed to create a learning culture as a sub-element of the overall programme of work. Working with individual project leaders, the intention was to shift the emphasis away from classroom based education, to learning at and from work. This was achieved through a combination of action research, the application of adult learning theory and facilitation. The paper describes the context of the development strategy, the facilitation processes adopted including the theoretical underpinnings and some 'tentative' outcomes achieved.

Adult↗
PubMed2000

Future directions for gerontology: a nursing perspective.

This paper discusses the contribution nursing has made to the development of person-centred services, and the influence of gerontology upon such developments. It examines traditional attitudes to medicine and nursing, when curing was all-important and caring treated as secondary and the shift away from this attitude to a more holistic approach to nursing, where the dignity of the patient is an important issue. It argues that good practice utilizes different sources of knowledge, including intuitive knowledge, and discusses the integrated programme of policy, development, research and education activities that the Royal College of Nursing is developing. The options currently available to anyone wishing to study gerontology are discussed, and the pros and cons of the current emphasis on broad-based clinical and educational experience prior to specialization analysed. The key aim of the RCN is to develop the specialism of gerontological nursing and the quality of care experienced by older people. With this end in view, this paper describes the education programme being developed by the RCN, leading to the award of Gerontological Nurse Specialist--a person able to demonstrate knowledge of rehabilitation, clinical assessment, health care assessment and a holistic knowledge of the ageing process.

Aged↗
PubMed1999

Vaccine entrapment in liposomes.

The use of liposomes as carriers of peptide, protein, and DNA vaccines requires simple, easy-to-scale-up technology capable of high-yield vaccine entrapment. Work from this laboratory has led to the development of techniques that can generate liposomes of various sizes, containing soluble antigens such as proteins and particulate antigens (e.g., killed or attenuated bacteria or viruses), as well as antigen-encoding DNA vaccines. Entrapment of vaccines is carried out by the dehydration-rehydration procedure which entails freeze-drying of a mixture of "empty" small unilamellar vesicles and free vaccines. On rehydration, the large multilamellar vesicles formed incorporate up to 90% or more of the vaccine used. When such liposomes are microfluidized in the presence of nonentrapped material, their size is reduced to about 100 nm in diameter, with much of the originally entrapped vaccine still associated with the vesicles. A similar technique applied for the entrapment of particulate antigens (e.g., Bacillus subtilis spores) consists of freeze-drying giant vesicles (4-5 microm in diameter) in the presence of spores. On rehydration and sucrose gradient fractionation of the suspension, up to 30% or more of the spores used are associated with generated giant liposomes of similar mean size.

Bacteria↗
PubMed1999

Determining older people's need for registered nursing in continuing healthcare: the contribution of the Royal College of Nursing's Older People Assessment Tool.

This paper presents an overview of the work of the Royal College of Nursing (RCN) in developing an assessment tool to determine the need for registered nursing by older people in continuing care. In the past, healthcare has been provided free and social care 'means-tested'. The erosion of the NHS's responsibility for continuing care provision through the development of eligibility criteria has resulted in the majority of older people having their care services means-tested, including their nursing care. The RCN has argued that older people have inter-related health and social care needs, that nursing care is an integral component of healthcare provision and that therefore older people should not have to pay for nursing care. This paper describes the work undertaken by the RCN to develop a tool for use in assessing older people's need for registered nursing--'The RCN Nursing Older People Assessment Tool'. The underpinning theoretical framework is outlined and the process of constructing the tool is described. In addition, the stages of assessment using the tool are outlined. A pilot study in seven nursing homes managed by three different companies was undertaken to test the reliability and acceptability of the tool. 178 paired assessments were completed (89% of the intended sample). The results of the pilot study demonstrated that the tool has a high degree of reliability and acceptability.

Aged↗
PubMed1999

Towards practice development--a vision in reality or a reality without vision?

This paper describes the development of a conceptual framework for practice development. Drawing on the authors' combined experiences of facilitating developments in practice, a conceptual framework is proposed. It is argued that much practice development in health care today lacks a systematic approach and is often undertaken by individual practitioners who are poorly prepared for their roles. A short history of practice development is outlined to contextualize current development activities. The proposed framework is located in a critical social science philosophy and it is suggested that such a philosophy enables individual growth and development, empowerment of practitioners and the generation of cultural change that sustains continuous growth and innovation in practice. An example of the framework in use is described and recommendations proposed to enable organizations to embrace a systematic approach to practice development.

Clinical Competence↗
PubMed1998

Femoral cementing techniques in total hip replacement.

Clinical studies have shown that second-generation femoral cementing techniques at total hip replacement result in a superior fixation of the femoral stem. In an effort to determine what benefits further developments in cementing techniques would provide, we compared the morphology of the cement mantles produced by traditional finger-packing and gun-insertion techniques. The porosity of the cement mantles was quantified using computerised image analysis. The finger-packing technique caused large air inclusions that resulted in large pores in the substance of the cement mantle, whereas the cement-gun technique did not result in any individual pore with an equivalent diameter greater than 3 mm. The mean porosity of cement mantles prepared using the finger-insertion technique was 8.3%, whereas the mean porosity in gun-prepared mantles was 1.7%. The use of a cement gun significantly reduced the porosity of femoral cement mantles (P = 0.02). Reduction of defects in the substance of the cement mantle may account for the increased survival of femoral prostheses inserted when second-generation techniques were used. Further reduction of the porosity of the cement mantle could not be expected to produce as dramatic a clinical improvement in prosthesis fixation.

Arthroplasty, Replacement, Hip↗
PubMed1998

Using a supervisory framework to support and evaluate a multiproject practice development programme.

The paper describes a multiproject practice development programme undertaken over a period of 1 year. The background and development of the programme are outlined, whilst attention is paid to the innovatory nature of the work, particularly the use of inductive, deductive and integrated approaches to both change implementation and project supervision. The programme was monitored throughout using different data sources and the paper uses evaluative material retrospectively to provide answers to organizational and professional difficulties which arose during the course of the programme. The authors conclude that the use of combinations of different models for practice development has potential, but requires careful supervision. They also recommend that those involved in practice development are made fully aware of its local or micropolitics, and develop strategies to deal with change before it occurs, not after it has taken place.

Evidence-Based Medicine↗
PubMed1998

Enabling the implementation of evidence based practice: a conceptual framework.

The argument put forward in this paper is that successful implementation of research into practice is a function of the interplay of three core elements--the level and nature of the evidence, the context or environment into which the research is to be placed, and the method or way in which the process is facilitated. It also proposes that because current research is inconclusive as to which of these elements is most important in successful implementation they all should have equal standing. This is contrary to the often implicit assumptions currently being generated within the clinical effectiveness agenda where the level and rigour of the evidence seems to be the most important factor for consideration. The paper offers a conceptual framework that considers this imbalance, showing how it might work in clarifying some of the theoretical positions and as a checklist for staff to assess what they need to do to successfully implement research into practice.

Evidence-Based Medicine↗
PubMed1998

Build consensus and develop collaborative practice guidelines.

With differing treatment guidelines available from many sources, collaborating advanced practice nurses and physicians at this facility recognized the need for one clear, acceptable set. Survey results show that clinicians incorporate all or most of the guidelines into practice (91%).

Ambulatory Care↗
PubMed1996

Comparative studies of the fate of free and liposome-entrapped hydroxypropyl-beta-cyclodextrin/drug complexes after intravenous injection into rats: implications in drug delivery.

Inclusion complexes of 14C-labelled hydroxypropyl-beta-cyclodextrin (HP beta-CD) with tritiated dehydroepiandrosterone (DHEA), retinol (RET) and dexamethasone (DEX) were entrapped in the aqueous phase of liposomes composed of distearoyl phosphatidylcholine. Incubation of liposome-entrapped complexes in the presence of rat blood plasma at 37 degrees C resulted in complex dissociation and drug leakage in the media at a rate which was minimal for DEX/HP beta-CD (11%), modest for RET/HP beta-CD (23%) and considerable for DHEA/HP beta-CD (56%; 60 min). In contrast, the HP beta-CD moiety of the complexes was retained by liposomes quantitatively. Free complexes injected intravenously into rats were cleared rapidly from the circulation with most (up to 94%) of the HP beta-CD moiety recovered in 24 urine together with lesser and variable amounts of drug (up to 46% of the dose) in a pattern (DHEA < RET < DEX) that was consistent with the extent of drug association with HP beta-CD in the presence of plasma. A significant proportion of the drugs (up to 25% of the dose)(but very little HP beta-CD) was removed by the liver where drugs were catabolised rapidly, probably following complex dissociation and transport to the tissue via plasma proteins. Injection of entrapped complexes revealed that liposomes alter their pharmacokinetics with only 6-13% of HP beta-CD and a moderate proportion of drugs (up to 26% of the dose) recovered in the urine. Much of the HP beta-CD moiety of the liposomal complexes was recovered in the liver (up to 83%) and spleen (up to 13% of the dose) by 30 min after injection, together with a variable proportion of drugs in a pattern (DHEA < RET < DEX) which reflected that of complex dissociation in vitro. Longer term experiments where animals injected with liposome-entrapped complexes were killed at time intervals (up to 24 days), revealed that HP beta-CD is eliminated from the tissues, albeit at a very slow rate. Moreover, the metabolism of individual drugs in the tissues following vesicle disintegration, appeared to depend on the rate of complex dissociation with DEX, for instance, reaching values of 4-6% (liver) only after 14 days. It is concluded that administration of drug/cyclodextrin inclusion complexes via liposomes could serve as a means to control the action of a wide range of therapeutic agents.

2-Hydroxypropyl-beta-cyclodextrin↗
PubMed1996

Developing outcome indicators in continuing care: part 2.

In their follow-up to last week's article which described the development of outcome indicators for nursing older people in continuing care settings, the authors describe in detail the process of indicator development. Referring to theoretical models, they provide a practical example of how a nurse could use one of his or her experiences from nursing to illustrate the distinct value of patient interventions provided by a registered practitioner.

Aged↗
PubMed1996

Developing outcome indicators in continuing care: part 1.

In the first of two articles, the authors describe the development of outcome measures for nursing older people in a continuing care setting. They describe why such a process was initiated and the framework which guided the project, including current nursing and government policy and theories of knowledge and expert practice. The second article will appear next week.

Accidental Falls↗
PubMed1995

The development of clinical leadership through supported reflective practice.

The notion of clinical leadership is significant in current nursing practice, particularly since recommendations made by the Department of Health in 'The Strategy for Nursing'. However, while it is a concept that many nurses aspire to implement, in reality the operationalizing of such a concept is fraught with difficulty. This paper aims to explore the issue of clinical leadership through a collegiate model developed in a particular practice area. The development of this collegiate relationship is articulated through the mediums of reflective practice and clinical supervision. A model of collegiality is offered as an approach to the integration of the spheres of clinical leadership. If reflective practice is to be a reality then it is essential that both clinical leaders and practitioners engage in such processes within a supportive culture.

Clinical Competence↗
PubMed1995

Latex sensitivity: an occupational health strategic plan.

1. Health care workers, due to ongoing exposure to latex products, may be at risk of developing latex sensitivity. 2. The spectrum of reactions related to medical glove use varies in severity. Awareness of latex sensitivity is heightened through worker education. 3. Guidelines and interventions for occupational health nurses are outlined so that workers who present with symptoms of occupational sensitivities related to latex products can be identified and assessed. 4. Occupational health nurses are effective resources for workers and managers on issues of latex allergy and appropriate accommodation.

Decision Trees↗
PubMed1994

Entrapment of cyclodextrin-drug complexes into liposomes: potential advantages in drug delivery.

A novel concept in drug delivery discussed here, takes advantage of certain properties of the drug "containers" cyclodextrins and liposomes to combine them into a single system thus circumventing problems associated with both systems. The concept, entailing entrapment of water-soluble cyclodextrin-drug inclusion complexes in liposomes, would allow accommodation of insoluble drugs in the aqueous phase of vesicles. This would potentially increase the drug to lipid mass ratio to levels above those attained by conventional drug incorporation into the lipid phase, enlarge the range of insoluble drugs amenable to encapsulation to include, for instance, membrane destabilizing agents, allow targeting of complexes to specific sites and reduce toxicity. In the present work, soluble inclusion complexes of hydroxypropyl-beta-cyclodextrin with dehydroepiandrosterone, retinol and retinoic acid were prepared and entrapped into multilamellar liposomes by the dehydration-rehydration procedure. Complex-containing liposomes were then exposed to blood plasma. Results show that complex entrapment into liposomes depends on the lipid composition used. Nearly all of the cyclodextrin and considerable portions of the drugs were found to remain associated with the carrier in the presence of plasma.

Animals↗