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Biomedical subjects

B O'Brien

Publications and source records attributed to B O'Brien.

At least 73 records · Page 4Linked to original sources
PubMed1996

Critical aspects of nursing in aged and extended care.

An ageing Australian population and improving medical retrieval technology have led to an increasing need for nurses to manage complex and acute health issues of ageing and chronic disability. In a study of aged and extended care involving nurses, residents, allied health professionals and family members, investigators used semi-structured interviews to identify critical aspects of nursing. The aim of the study was to begin to identify and illustrate a theoretical framework of "critical' nursing activities for aged and extended care. Two important themes to emerge were the structure of the health care setting and the characteristic behaviours of people associated with it. These themes reinforce the importance of treating people as individuals and of describing caring criteria in ways which reinforce holism.

Aged↗
PubMed1996

A novel multicolor hybridization scheme applied to localization of a transcribed sequence (D10S170/H4) and deletion mapping in the thyroid cancer cell line TPC-1.

The sequence-tagged site (STS) D10S170, also referred to as H4, is a gene of unknown function. Its 5' end was found fused to the catalytic domain of the RET protooncogene to generate RET/PTC 1, the most common form of PTC oncogenes in human papillary thyroid carcinoma. This gene has previously been assigned to a very large genomic region, 10q11.22-->q22.1. Here, we describe the application of a novel hybridization scheme to the physical and genetic mapping of D10S170. First, we selected a homologous large-insert DNA clone from a human P1 library by filter hybridization and confirmed its authenticity by Southern blot analysis. Triple-color fluorescence in situ hybridization (FISH) experiments mapped this clone to l0q21.2-->q21.3. "Binning" experiments were performed using a quadruple-color FISH approach aimed toward placing the gene in a genetic interval defined by differentially labeled P1 DNA probes containing known polymorphic markers. We found that multicolor FISH greatly expedites chromosomal mapping. Finally, we applied our FISH approach to determine the extent of deletion involving this locus (D10S170) in a papillary thyroid cancer cell line, TPC-1.

Carcinoma, Papillary↗
PubMed1995

Cost-effectiveness of Helicobacter pylori eradication for the long-term management of duodenal ulcer in Canada.

BACKGROUND: A 1994 National Institutes of Health consensus panel recommended that eradication of Helicobacter pylori should be first-line therapy for persons with duodenal ulcer. OBJECTIVE: To assess the cost-effectiveness of H pylori eradication relative to alternative pharmacologic strategies in the long-term management of persons with confirmed duodenal ulcer. METHODS: Decision analysis model to estimate expected costs and symptomatic ulcer recurrences during a 12-month period for three general treatment strategies: (1) immediate H pylori eradication; (2) H pylori eradication at first ulcer recurrence; and (3) continuous maintenance therapy with a histamine2 receptor antagonist (ranitidine hydrochloride). Two H pylori eradication therapies were compared: classic triple therapy and omeprazole plus amoxicillin. Probabilities for ulcer recurrence are by meta-analysis of published randomized trials. Health care resources used in the management of duodenal ulcer recurrence were by expert physician panel. All costs are in 1993 Canadian dollars. RESULTS: Duodenal ulcer recurrence at 6 months (symptomatic and asymptomatic) with placebo was 65.4% and 12.8% with maintenance ranitidine therapy. Where eradication of H pylori was successful (85% of patients), the ulcer recurrence rate to 12 months was 3.7%. Treatment with ranitidine and triple therapy to eradicate H pylori on first presentation has an expected 1-year cost of $253 with 15 symptomatic recurrences per 100 patients; H pylori eradication by omeprazole plus amoxicillin had similar expected costs ($272) and outcomes (15 recurrences per 100 patients). Both of these early H pylori eradication strategies were dominant (less costly with same or better outcomes) over intermittent or continuous maintenance ranitidine therapy or delayed (after first recurrence) H pylori eradication. CONCLUSION: Our analysis provides economic evidence in support of the recent guidance that for persons with duodenal ulcer, early attempts to eradicate H pylori are recommended.

Canada↗
PubMed1995

Discrimination and abuse experienced by general internists in Canada.

OBJECTIVE: To identify the frequency of psychological and emotional abuse, gender discrimination, verbal sexual harassment, physical sexual harassment, physical assault, and homophobia experienced by general internists. DESIGN: Cross-sectional survey. SETTING: Canadian general internal medicine practices. RESULTS: The overall response rate was 70.6% (984/1,393); the 501 respondents who classified themselves as general internists were studied. Three-fourths of the internists experienced psychological and emotional abuse at the hands of patients, and 38% of the women and 26% of the men experienced physical assault by patients. The majority of the female internists experienced gender discrimination by patients (67%) and by physician peers (56%). Forty-five percent of the women experienced verbal sexual harassment by patients, and 22% experienced physical sexual harassment by patients. The male internists experienced verbal sexual harassment from nurses slightly more often than the female internists did (19% vs 13%, p > 0.05). Verbal sexual harassment by male colleagues was reported by 35% of the female internists, and physical sexual harassment was reported by 11%. Approximately 40% of general internists reported homophobic remarks by both health care team members and patients. CONCLUSIONS: Abuse, discrimination, and homophobia are prevalent in the internal medicine workplace. A direct, progressive, multidisciplinary approach is necessary to label and address these problems.

Adult↗
PubMed1995

Preserving self: from victim, to patient, to disabled person.

Open-ended, unstructured interviews were conducted with patients who had survived serious traumatic injury, and their experiences from impact to recovery analysed using grounded theory. A four-stage process of 'vigilance', 'disruption', 'enduring the self', and 'striving to regain the self' was delineated. The basic social psychological process of 'preserving self' explained the strategies used in each stage, and required deliberate action, focused energy and tremendous effort and will. The strategies used to preserve self changed in each stage of the model. At the beginning, when physical survival was in jeopardy, the strategies were primarily physical. Protecting self was a process of 'taking time out' and of shutting down, in the stage of disruption. In the stage of enduring the self, it was passively learning to 'take it' and to bear the treatments. Finally, in the stage of striving to regain the self, preserving the self was the work of regaining and redefining the self as a disabled person.

Adaptation, Psychological↗
PubMed1995

Variables related to nausea and vomiting during pregnancy.

Seventy to 90 percent of all pregnant women experience nausea, and 50 percent have at least one episode of vomiting or retching. A continuous measure was used to quantify symptoms of nausea with or without vomiting or retching during pregnancy in 126 women. Relationships between symptoms and selected variables were evaluated. Nausea with or without vomiting or retching was associated with maternal age, occupation, parity, cigarette smoking, infant gender, and the personality trait of independence. Significant associations were entered into multiple regression equations. Fourteen percent of the variation in symptoms overall, 25.1 percent of the variation in nausea symptoms, and 16.6 percent of the variation in vomiting or retching symptoms were explained by a combination of these selected independent variables. Although this study found associations, independent variables contributed little to predicting or explaining the presence and severity of nausea and vomiting during pregnancy. More sensitive measures and evaluation are required to understand and treat this perplexing phenomenon.

Female↗
PubMed1995

Development and application of a monoclonal antibody against Thiothrix spp.

Historically, methods used to identify Thiothrix spp. in environmental samples have been inadequate because isolation and identification procedures are time-consuming and often fail to separate Thiothrix spp. from other filamentous microorganisms. We described a monoclonal antibody-based enzyme-linked immunosorbent assay (ELISA) procedure which was used to identify Thiothrix spp. in wastewater, artesian springs, groundwater, and underwater subterranean samples. The ELISA utilized monoclonal antibody T3511 to a species-specific carbohydrate epitope of Thiothrix spp. No cross-reactions were observed among non-Thiothrix strains consisting of 12 species and nine genera. In field trials, the ELISA identified 100% of 20 biochemically and cytologically confirmed Thiothrix spp.-containing samples with no false positives. Indirect immunofluorescent microscopy utilizing T3511 was effective for wastewater samples but not for those from natural spring water because of background fluorescence in the latter. In addition, electron micrographs of Thiothrix spp. labeled with T3511-biotin-anti-mouse antibody-gold showed that epitope T3511 was intracellular both in laboratory strains and environmental isolates. The minimum level of detection of the ELISA was 0.10 microgram/ml.

Antibodies, Bacterial↗
PubMed1995

Nine steps to better nursing management of incontinence.

This paper describes the development of a new framework for nursing assessment and management of incontinence using action research (Gibb, O'Brien, Bradford and Curtis 1993). The authors worked with nurses and residents in a large extended care setting--clarifying their current understandings of continence issues and looking at ways of improving incontinence management. This process led to the development of a model for assessment and management of incontinence.

Clinical Nursing Research↗
PubMed1995

Principles of economic evaluation for health care programs.

There is a growing demand for economic evaluation of new therapeutic interventions to provide health care decision makers with information on the relative value for money offered by alternative treatments. We review the rationale for economic evaluation and distinguish between 4 analytic techniques: cost minimization analysis, cost effectiveness analysis, cost utility analysis, and cost benefit analysis. Each technique is illustrated with an example from the literature.

Costs and Cost Analysis↗
PubMed1995

Expanding the role of the clinical nurse consultant.

This paper describes the phases that were experienced by clinical nurse consultants during a role transition from ward-based experts to facility-oriented resource people. The six prerequisites that the consultants identified as required for successful transition from the ward-based to the facility-oriented role are discussed. The increased productivity of the CNCs is summarised and recommendations for further action are identified.

Adaptation, Psychological↗
PubMed1995

A cost effectiveness analysis of urate lowering drugs in nontophaceous recurrent gouty arthritis.

OBJECTIVE: To determine in a Canadian health care setting the cost effectiveness of urate lowering drugs (ULD) in the treatment of nontophaceous gouty arthritis with recurrent attacks and to evaluate the least costly regimen among available ULD. METHODS: A decision analysis model was designed using hypothetical cohort of patients who present 1 to 4 recurrent attacks/year. It incorporated costs and probabilities estimated from the published literature. Effectiveness was defined as the number of recurrent attacks averted by each treatment strategy (ULD or No ULD). The incremental cost effectiveness ratio was defined as the ratio of the additional cost incurred by a management strategy compared with the additional benefit derived from it. A multiway sensitivity analysis was built to allow the modelling of extreme case scenarios favoring (best ULD scenario) and disfavoring (worst ULD scenario) the ULD therapy. RESULTS: Using the baseline scenario estimates for the hypothetical cohort of patients presenting one attack/year, the total annualized costs per patient associated with ULD and No ULD treatment were Cdn $426.27 and 267.27, respectively. The average cost effectiveness ratios were $592.25 and 5,345.37, respectively, per attack averted. For this cohort of patients the incremental cost effectiveness ratio ranged from $99.59 (best ULD scenario) to 489.26 (worst ULD scenario). The treatment with ULD is cost saving if patients present 2 or more attacks/year. Allopurinol in its generic formulation was the ULD that presented the lowest incremental cost effectiveness ratio. CONCLUSION: ULD treatment is cost effective. It is also saving if patients present 2 or more recurrent attacks/year.

Allopurinol↗
PubMed1994

Independent in vitro assembly of a ribonucleoprotein particle containing the 3' domain of 16S rRNA.

Small (30S) subunits of Escherichia coli ribosomes are composed of 21 proteins and a 1542-nucleotide 16S rRNA, whose secondary structure is divided into three domains. An in vitro transcript of the 3' domain of 16S rRNA (residues 923-1542), assembles efficiently with 30S ribosomal proteins to form a compact ribonucleoprotein (RNP) particle. Isolated particles examined under the electron microscope have a globular appearance, similar in size and shape to the head of the 30S ribosomal subunit. Two-dimensional gel analysis of the particles indicates the presence of proteins S3, S7, S9, S10, S13, S14, and S19 and smaller amounts of S2, all of which have been localized to the head of the 30S subunit by immunoelectron microscopy and neutron diffraction and belong to the S7 assembly family. Interestingly, protein S4, which is believed to interact exclusively with the 5' domain, is also reproducibly found associated with the particles in significant amounts. Chemical probing of the RNA in the assembled particle reveals characteristic cleavage protection patterns, showing that the proteins assemble with the 3'-domain RNA similarly to the way in which they assemble with 16S rRNA, although some of the later steps of assembly appear to be incomplete. These results show that the 3' domain of 16S rRNA can indeed assemble independently of the rest of the 30S subunit into a particle that resembles its structure in the ribosome. In addition, the assembled particles are able to bind spectinomycin with an affinity comparable to that of 30S subunits.

Base Sequence↗
PubMed1994

How was your hospital stay? Patients' reports about their care in Canadian hospitals.

OBJECTIVE: To survey adult medical and surgical patients about their concerns and satisfaction with their care in Canadian hospitals. DESIGN: Cross-sectional telephone survey undertaken from June 1991 to May 1992 with a standardized questionnaire. SETTING: Stratified random sample of public acute care hospitals in six provinces; 57 (79%) of the 72 hospitals approached agreed to participate. PATIENTS: Each participating hospital provided the study team with the names of 150 adult medical and surgical patients discharged home in consecutive order. A total of 4599 patients agreed to be interviewed (69% of eligible patients and 89% of patients contacted). MAIN OUTCOME MEASURES: Satisfaction with (a) provider-patient communication (including information given), (b) provider's respect for patient's preferences, (c) attentiveness to patient's physical care needs, (d) education of patient regarding medication and tests, (e) quality of relationship between patient and physician in charge, (f) education of and communication with patient's family regarding care, (g) pain management and (h) hospital discharge planning. RESULTS: Most (61%) of the patients surveyed reported problems with 5 or fewer of the 39 specific care processes asked about in the study. Forty-one percent of the patients reported that they had not been told about the daily hospital routines. About 20% of the patients receiving medications reported that they had not been told about important side effects in a way they could understand; 20% of the patients who underwent tests reported similar problems with communication of the test results. Thirty-six percent of those having tests had not been told how much pain to expect. In discharge planning, the patients complained that they had not been told what danger signals to watch for at home (reported by 39%), when they could resume normal activities (by 32%) and what activities they could or could not do at home (by 29%). Over 90% of the patients reported that they had had a relationship of confidence and trust with their physician and that they had been involved in decision making as much as they wanted to be. Fifteen percent of the patients whose admissions had been scheduled felt that they should have been admitted sooner. CONCLUSION: The self-reported patient data from this survey suggest that hospital routines, medications, tests, pain management and discharge planning are areas of communication to target in future quality-improvement efforts in Canadian hospitals.

Adult↗
PubMed1994

Relationship between symptoms and health-related quality of life in chronic lung disease.

The authors studied the relationship between patient self-reported symptoms and responses to a general measure of health-related quality of life [Short Form 36 (SF-36)] for 102 patients who had chronic lung disease [forced expiratory volume in one second (FEV1) < 70%]. The primary diagnoses were chronic bronchitis, emphysema, and asthma; the mean age was 62 years, and 46% were women. Based upon Medical Research Council (MRC) symptom scores, the patients' disease severity was classified as mild (21%), moderate (22%), or severe (57%). The SF-36 scores differed significantly between disease severity groups in domains of health perception, physical functioning, physical role, and energy. The SF-36 physical functioning and Oxygen Cost Diagram scores correlated well (r = 0.78). The authors conclude that SF-36 is a useful and valid measure of general health status in patients with chronic lung disorders.

Female↗
PubMed1994

Prevalence of migraine headache in Canada: a population-based survey.

BACKGROUND: The aim of the present study was to estimate the prevalence of migraine headache among Canadian adults (aged > or = 18 years) and analyse variation by age, gender, household income and province of residence. METHODS: A population-based survey was undertaken using telephone interviews with 2922 adults who were randomly selected from households across Canada by stratified regional sampling. The questionnaire asked about frequency and characteristics of headaches experienced and other symptoms. The diagnostic criteria of the International Headache Society were used to classify people as migraineurs (with or without aura), headachers or non-headachers. RESULTS: Of 8921 random calls to households, 4235 were eligible and 2922 interviews were successfully completed (response rate 66%). The prevalence of migraineurs, headachers and non-headachers among males was 7.8%, 76.1%, 16.1% and among females was 24.9%, 65.6%, 9.4%. For females prevalence appears to increase with age, peaking at 40-44 years and declining thereafter. Sex-specific prevalence for males and females, controlling for age, was significantly lower in the province of Quebec compared to other provinces. We found no association between migraine prevalence and household income. Of 500 people classified by IHS criteria as migraineurs only 232 (46%) reported any migraine diagnosis by a physician. CONCLUSION: We estimate that 2.6 million adult females and 0.8 million adult males in Canada are migraineurs, but only half are likely to have been diagnosed by a physician. Contrary to a recent US survey, people from lower income households in Canada are not at greater risk of migraine. The lower prevalence of migraine in Quebec was unexpected and remains unexplained, but it may be influenced by language/translation problems.

Adult↗
PubMed1994

Quality circles: one organization's experience.

Decentralization of quality assurance activity or total quality management (TQM) is a goal set by many health services. Effective and efficient use of available resources is usually the goal. This article describes the efforts of one organization to decentralize its nursing quality assurance program. Quality circles provided forums for an increasing acceptance by ward-based nurses of their role in establishing quality as central to nursing practice. This emphasis on local group processes has helped staff to work with each other to solve problems related to the work of nursing.

Attitude of Health Personnel↗