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B O'Brien

Publications and source records attributed to B O'Brien.

At least 55 records · Page 3Linked to original sources
PubMed1998

Nursing competencies: ground work in aged and extended care.

Competencies have been formulated for entry level nurses. Specialist and generic advanced nursing competencies are also being developed. This paper describes exploratory groundwork on aged and extended care nursing competencies derived from interviews with nurses, allied health staff, residents and their families from one setting. Critical Incident Technique1 was used to guide semistructured interviews with 29 participants. A thematic analysis of the data suggests that the Australian Nursing Council Inc.2 competencies make a useful but incomplete contribution to understanding the perceived role of nursing in aged and extended care. A conceptual framework developed from the data illustrates the interdependence of competencies with the context in which they are observed. The framework proposes a number of elements which have the potential to offer a means to better interpret nursing competence (critical aspects) in aged and extended care contexts.

Aged↗
PubMed1998

First International Pharmacoeconomic Conference on Alzheimer's Disease: report and summary.

The First International Pharmacoeconomic Conference on Alzheimer's Disease (AD) was held in Amsterdam in July 1998. The meeting was held under the auspices of the International Working Group for Harmonization of Dementia Drug Guidelines (http://dementia.ion.ucl.ac.uk/harmon), bringing together academics, clinicians, purchasers, and representatives from industry. Presentations were given on the methodology of pharmacoeconomic studies in AD, particularly focusing on caregiver burden, quality of life (QOL), and resource utilization. Three economic models of AD were presented based on data from the United States, Canada, and the United Kingdom. In two studies, these data were then used to model the cost-effectiveness and effect on cost of treatment with donepezil. Both studies suggested a possible cost advantage for the use of donepezil, when compared with no placebo or treatment, particularly when donepezil is used appropriately in mild-to-moderate AD. These data need to be interpreted with care, as none of the cost or utility information were collected during the clinical trials. Additional data from a 2-year clinical trial of selegiline and vitamin E suggest that cognitive measures may be poor predictors of economic outcome, which is better measured directly. Both economic models of donepezil rely on short-term cognitive data to predict long-term outcome, a methodf that may not be useful in predicting economic savings. The issues facing pharmacoeconomists, researchers, clinicians, and families in the future were addressed in a series of workshops using a method of strategic futuring. The workshops attempted to see 7 years into the future for a range of areas, including consumer and caregiver use of pharmacoeconomic data; early detection and prevention; Japanese perspectives; activities of daily life and what will be daily life activities; caregiver burden; QOL at the end of life; new uses for new information and communication technology in clinical research; and physicians' use of pharmacoeconomic data. A range of exciting futures were predicted, although common themes that arose when considering barriers to achieving these futures included cost, education, political will, confidentiality, privacy, and ethics. The first conference was deemed to have been a success, having attracted more than 160 delegates and many distinguished speaker. A second conference is planned for the year 2000. Over the next 2 years, research needs to be broadened particularly in the methodological areas of resource utilization, QOL, and caregiver burden. Data from clinical trials with relevant economic and QOL outcomes will be needed by purchasers if drug treatments for dementia are to gain widespread use. It is also hoped that the models described at the meeting may become more freely available to politicians, purchasers, clinicians, and caregivers to help them make better decisions about treatment.

Aged↗
PubMed1998

Older men's concerns about their urological health: a qualitative study.

While there has been widespread recent interest in men's health issues, and prostate cancer in particular, there have been few studies to determine which issues are important from the viewpoint of men themselves. This study was undertaken to identify genitourinary issues of concern to older men. A series of 19 focus groups involved 137 men and 14 women from a broad demographic background. Men expressed consistent concern about urinary symptoms, prostate cancer and sexual function. They revealed misunderstanding and a desire for more information about all issues. Urinary symptoms had a high impact on quality of life that could be made worse by environmental constraints such as working conditions and availability of toilets. Prostate cancer was a concern in all groups, even those at low risk, and men believed that screening for prostate cancer should be offered. Men believed sexuality was not recognised as an issue of concern to older people. Potential barriers to health action included stoicism, not talking about health issues and poor relationships with doctors. The study suggests a substantial need for community and professional education and for health promotion focused on preventable morbidity.

Adult↗
PubMed1998

Nursing management of multiple enterocutaneous fistulae located in the center of a large open abdominal wound: a case study.

Large abdominal wounds complicated by enterocutaneous fistulae require creative pouching techniques and wound care. Knowledge of containment devices, principles of pouching and appropriate wound management can promote an optimal level of care. After undergoing debridement and drainage of intra-abdominal and pelvic abscesses, a 55 year old surgical patient was left with a large ECF/wound requiring a creative pouching technique. Because the abdominal area was quite extensive, the larger drainable pouches and wound management devices would not accommodate the width of the wound bed. An effective pouching method was achieved using various skin barriers, adhesives and a bowel isolation bag. This system enabled the patient to ambulate and perform many other ADLS while containing moderate to large amounts of effluent. Most of all, this method provided comfort and a sense of dignity while preventing post surgical complications.

Abdomen↗
PubMed1998

An evaluation of rectal mucosal proliferation measure variability sources in the polyp prevention trial: can we detect informative differences among individuals' proliferation measures amid the noise?

We assessed components of total variability of bromodeoxyuridine (BrdUrd) and proliferating cell nuclear antigen (PCNA) assays of rectal mucosal proliferation in a subset of 390 participants from the U. S. National Cancer Institute's multicenter Polyp Prevention Trial. Biopsies were blindly double-scored by two technicians. For those participants for whom at least one evaluable biopsy was obtained, a mean of 2.0 and 2.6 biopsies, and 6.2 and 8.7 crypts/biopsy were evaluated, respectively, with the BrdUrd and PCNA assays. Factors such as clinical center, scorer, and month of biopsy collection significantly affected the observed values of the labeling index (LI) and proliferative height (PH). Therefore, it is essential to control or adjust for these variables in proliferation studies. Sources of random variation for LI and PH measures remaining after the aforementioned factors include between-participant variation and several sources of within-participant variation, including variation over time, between biopsies, and between multiple measurements on the same biopsy. Both LI and PH measurements exhibited substantial variability over time, between biopsies, and from reading-to-reading of the same biopsy. When other sources of variability have been accounted for, the PCNA LI seems to have little between-participant variation. This brings into question its utility as a marker in colorectal cancer studies. The PCNA PH showed significant between-participant variability and may hold some promise as a useful marker in colorectal cancer studies. Results for BrdUrd were less conclusive. The BrdUrd LI showed marginally significant between-participant variation, whereas the corresponding variation for PH was nonsignificant.

Adult↗
PubMed1997

Particulate matter in the posterior semicircular canal.

The pathoetiology of benign paroxysmal positional vertigo (BPPV) is controversial. Particulate matter within the posterior semicircular canal has been identified intraoperatively in patients with BPPV but has also been reported in non-BPPV patients at the time of translabyrinthine surgery (Parnes LS, McClure JA. Free-floating endolymphatic particles: a new operative finding during posterior semicircular canal occlusion. Laryngoscope 1992;102:988-92; Schuknecht HF, Ruby RRF. Cupulolithiasis. Adv Otorhinolaryngol 1973;20: 434-43; Kveton JF, Kashgarian M. Particulate matter within the membranous labyrinth: pathologic or normal? Am J Otol 1994;15:173-6). The nature of the particulate matter remains unknown. The purpose of this study was to prospectively examine the posterior semicircular canal of patients with and without a clinical history of BPPV for the presence of particulate matter. Seventy-three patients without BPPV symptoms undergoing labyrinthine surgery (vestibular schwannoma excision or labyrinthectomy) and 26 patients with BPPV undergoing the posterior semicircular canal occlusion procedure were compared. Additionally, 70 archived temporal bones without a history of BPPV were examined microscopically for the presence of particulate matter within the lumen of the membranous labyrinth. No particles were observed intraoperatively in any of the 73 patients without a history of BPPV. Particulate matter was observed in 8 of 26 patients at the time of the posterior semicircular canal occlusion procedure for intractable BPPV. Of the 70 temporal bones examined, 31 did not show significant postmortem changes and also did not demonstrate cupulolithiasis or canalithiasis. Particulate matter from within the membranous posterior semicircular canal was removed from one patient at the time of posterior semicircular canal occlusion for intractable BPPV symptoms and was examined by scanning electron microscopy. The particulate matter appeared morphologically consistent with degenerating otoconia. These data show a statistically significant association between the presence of particles within the posterior semicircular canal in this study and the symptom complex of BPPV.

Ear, Inner↗
PubMed1997

Using critical incident technique to inform aged and extended care nursing.

Flanagan's critical incident technique was used to explore the beliefs of a cross-section of careers (both nursing and others) and consumers about the value of nursing and the nature of nursing's contribution in aged and extended care. The exploratory study found that nurses' being there, with and for residents, their families, and other health professionals, was influenced by two major themes that emerged from the data: personal and structural considerations. In this article, the potential of critical incident technique as a research method in nursing and for generating information about critical aspects of nursing work in aged and extended care is demonstrated.

Adult↗
PubMed1997

Diary reports of nausea and vomiting during pregnancy.

Nausea and vomiting during pregnancy can have a profound effect on the lives of some women. Symptoms have been reported across cultures and throughout recorded history, but interventions that consistently relieve symptoms have not been documented. As part of a larger study, strategies or situations that stimulate or relieve nausea and vomiting or retching were evaluated qualitatively. Participants (n = 124) who experienced nausea during pregnancy with or without vomiting/retching kept a diary for 7 days, recording any interventions or symptom relief measures that they used, evaluating the effectiveness of these measures, and recording activities or situations that exacerbated their symptoms. Data from the diaries were categorized using content analysis. Rest, particularly napping, was a measure that was universally employed to relieve symptoms. Participants reported that almost any type of sensory perception could stimulate symptoms. Sensory stimuli were often exaggerated or altered, with perceptions of odors being profoundly affected. Implications for nursing practice are discussed.

Adaptation, Psychological↗
PubMed1997

Immunolocalization of bFGF in pterygia: association with mast cells.

PURPOSE: To examine the expression of basic fibroblast growth factor in pterygia and determine whether mast cells contain basic fibroblast growth factor (bFGF) in this disease process. METHODS: Formalin-fixed paraffin-embedded tissue samples of pterygia (n = 14) were used to study the expression of bFGF with immunohistochemistry. Seven samples were also double labeled with specific antibodies to bFGF and tryptase (a specific mast cell marker). RESULTS: In all tissue samples examined, bFGF was specifically localized in blood vessels, epithelium, and a subset of connective tissue cells. The majority of bFGF-positive connective tissue cells were also tryptase positive (90.4 +/- 3.6%). Nearly all the tryptase-positive cells (mast cells) in the pterygia tissues coexpressed bFGF (98 +/- 1.5%). CONCLUSIONS: These findings suggest that bFGF may have biologic effects on the epithelium and blood vessels in pterygia, with epithelial and endothelial cells as a possible source. In addition, mast cells contain bFGF in the pterygia tissues examined in this study. The mast cells may serve as an additional source of bFGF, possibly modulating a variety of cell types as well as the extracellular matrix in pterygia.

Adult↗
PubMed1997

A comparison of active and passive warm ups on energy system contribution and performance in moderate heat.

The effect of either an active warm up (AWU) or a passive warm up (PWU) on performance and energy system contribution in a moderately hot ambient environment (30 degrees C, 50% Relative humidity) was investigated. The AWU procedure involved exercise at 100% VO2 max followed by four 30 sec efforts at 100% of VO2 max and the PWU involved the application of heat pads to the quadriceps for 60 min. Following either warm up procedure, (randomized cross over design) a 60 s supramaximal test on a Monark bicycle ergometer was performed. The AWU procedure elicited the greatest average power output (0-30 s: 669 +/- 28 W vs 645 +/- 30 W, p < 0.05) and (0-60 s 529 +/- 20 W vs 513 +/- 20 W, p < 0.05), the greatest peak power output (917 +/- 45 W vs 880 +/- 46 W, p < 0.01) and VO2 peak during the initial 30 s (1.4 +/- 0.1 vs 1.2 +/- 0.1 l.min-1, p < 0.01) and over the duration of the 60 s test (3.2 +/- 0.1 vs 2.9 +/- 0.2 l.min-1, p < 0.05). The estimated anaerobic energy release was not significantly different between the trials. The performance benefits of an AWU occurred within the first 30 s of exercise as there was no significant differences in average power output or VO2 peak in the final 30 s of exercise. In conclusion, an AWU enhances sprinting performance in a moderately hot ambient environment, despite a higher rectal temperature than a PWU. The increased power output is derived from greater oxygen consumption in the initial stages of exercise.

Adult↗
PubMed1996

Blood lipids, cardiovascular fitness, obesity, and blood pressure: the presence of potential coronary heart disease risk factors in adolescents.

OBJECTIVE: To identify and compare the presence of coronary heart disease (CHD) risk factors among 14- and 15-year-old boys and girls. DESIGN: For this cross-sectional study of 54 subjects, a blood sample taken after subjects fasted was used to determine total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglyceride concentrations. Dietary intake was estimated using a 24-hour recall and a 2-day food record. Height, weight, and skinfold thicknesses were measured to identify obese and severely obese subjects. Cardiovascular fitness, blood pressure, and cigarette use also were measured. TC, HDL-C, LDL-C, fitness, blood pressure, and smoking are modifiable risk factors, for CHD. SUBJECTS: Adolescents were selected by random sampling from lists of students attending public schools in two central Texas cities. Adolescents who were 14 or 15 years old; were not pregnant; and had no history of high blood pressure, diabetes, or heart disease were eligible to participate. STATISTICAL METHODS: Data were analyzed using Student's t and chi square tests. RESULTS: Of the subjects, 25% demonstrated two or more risk factors for CHD. A significantly higher percentage of girls than boys had a TC concentration greater than 5.2 mmol/L. Boys (n=29) had a mean fitness score that indicated a higher level of cardiovascular fitness than girls (n=25); however, the mean score for both groups was below average. CONCLUSION: Data provide support for increased interventions targeted toward lowering the risk factors for CHD and other chronic diseases in adolescents.

Adolescent↗
PubMed1996

Efficacy of P6 acupressure in the treatment of nausea and vomiting during pregnancy.

OBJECTIVE: Our purpose was to investigate the efficacy of P6 acupressure in reducing or relieving symptoms of nausea with or without vomiting and retching during pregnancy. STUDY DESIGN: Symptomatic pregnant volunteers (n=161) participated in a 7-day community-based clinical trial. All participants were assigned to one of three groups (i.e., P6 acupressure, placebo [acupressure bands inappropriately placed], or control) on the basis of a process of blocked randomization. Data were analyzed by error bar charts and analysis of variance of difference scores. RESULTS: Of 161 women, 149 (92.5%) completed the protocol. Irrespective of group assignment, participants reported significant decreases in nausea (p<0.0009) and vomiting or retching (p<0.0009). However, there was no differential treatment effect as a result of acupressure. CONCLUSION: There was no apparent medical benefit from the use of P6 acupressure. Our findings differ from other recently published studies that did not include a control group.

Acupressure↗
PubMed1996

Learning opportunities for internal medicine residents: comparison of a tertiary care setting and a regional setting.

PURPOSE: To compare the learning opportunities for internal medicine residents in tertiary care and community hospital settings. METHOD: Two sites were studied: Victoria General Hospital, a teaching hospital affiliated with the Dalhousie University Faculty of Medicine, staffed by five general internists and serving Halifax County (population of 420,000); and South Shore Regional Hospital, serving the community of Bridgewater (with a catchment area of 50,000) and staffed by three general internists. All in- and outpatients seen in the two settings over a one-year period (1993) were described in accordance with the Canadian Institute for Health Information's major clinical categories, as well as a case mixture recommended as providing appropriate learning experiences for internal medicine clerks. Over a one-month period (August 1993), consecutive patients were interviewed, completing a health status questionnaire, the Medical Outcome Study Short Form 36 (SF-36). RESULTS: Data were collected from the records of 2,763 patients, and the SF-36 questionnaire was administered to 406 patients. The data indicate that the settings were relatively similar except that there was more case variety in the tertiary care setting, and that more patients with cardiovascular disease and no patient with acquired immune deficiency syndrome were seen in the regional setting. Quality-of-life scores showed similarities to norms in the United States and United Kingdom, except that the ambulatory patients in the regional setting had rather lower scores. CONCLUSION: Overall, the patients' problems in the regional and tertiary care settings offered similar learning opportunities.

Aged↗