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Biomedical subjects

B O'Brien

Publications and source records attributed to B O'Brien.

At least 91 records · Page 5Linked to original sources
PubMed1994

Increasing the recognition of delirium in elderly patients.

OBJECTIVE: To determine if an educational intervention aimed at house staff will increase knowledge about and recognition of delirium. DESIGN: Before/after study, with blinding of participants to the intent of the study. SETTING: University hospital in Halifax, Nova Scotia. PATIENTS: One hundred eighty-seven control patients, seen as consecutive admissions of elderly patients (65 + years) to the General Medicine services of the Victoria General Hospital prior to the educational intervention, and 247 patients seen thereafter. INTERVENTION: Educational intervention at grand rounds, housestaff rounds, sign-in rounds, and bedside teaching. MEASUREMENTS: Recognition of delirium in the admitting history or progress notes, Confusion Assessment Method (CAM) as recorded by nurses, diagnosis of delirium by independent study physicians using DSM-IIIR criteria and the Trzepacz Delirium Symptom Rating Scale. RESULTS: Prior to the intervention, delirium or acute confusion was diagnosed in 3% of patients; after the intervention, delirium or acute confusion was diagnosed in 9% of patients (P < 0.01). Other abnormalities in mental state were noted in 8.5% of admissions prior to the intervention, and 15.6% of admissions after the intervention. After the intervention there was a significant difference in the proportion of patients in whom a mental status questionnaire had been carried out and in whom there was formal comment on various aspects of the mental state. The nursing CAM had a sensitivity of 0.68 and a specificity of 0.97. CONCLUSIONS: A simple educational intervention aimed at house staff appears to be effective in changing house staff behavior. Improved recognition of delirium may lead to better patient outcomes.

Aged↗
PubMed1994

High dose rate versus low dose rate brachytherapy for squamous cell carcinoma of the cervix: an economic analysis.

Brachytherapy is an established and important part of the management of invasive carcinoma of the cervix. Available evidence suggests that low dose rate (LDR) and high dose rate (HDR) are equivalent in terms of tumour control, adverse effects and survival. Proponents of outpatient HDR argue that it is less costly than LDR, but no economic evaluation has been published. We compared the costs of HDR and LDR (capital, operating, maintenance, source and operating costs) for Nucletron intracavitary equipment under alternative assumptions about the number of patients treated per year, the number of insertions per patient and discount rate. For example, for 3 HDR fractionations compared with 1 LDR fractionation, the LDR-3 (Nucletron) is the most cost-effective, practical machine for up to 40 patients per year. Although LDR-3 is more cost effective for a greater number of patients, HDR would be recommended for more than 40 patients a year for practical reasons. Similarly, for 5 HDR compared with 2 LDR fractionations, LDR-3 would be recommended for up to 20 patients per year and HDR for a greater number of patients. Recommendations for other HDR/LDR fractionations and annual number of patients seen can be derived from the model. This recommendation is based on no cost sharing with other sites. Cost sharing was beyond the scope of this analysis, though the principles are similar to the ones used. The model may be adapted to help equipment decision-making for a brachytherapy programme for an individual centre.

Brachytherapy↗
PubMed1993

Clinical importance, statistical significance and the assessment of economic and quality-of-life outcomes.

The assessment of economic and quality-of-life outcomes of health care interventions is moving into a new era, with such assessments increasingly being made within the context of controlled clinical trials. Traditionally the measurement of many variables in economic evaluations, particularly costs, has been deterministic. In the context of clinical trials the measurement of variables is stochastic, with the standard principles of statistical inference being applied to analyse differences between treatments in terms of effectiveness. Economists participating in clinical research are therefore being called upon to specify the sample size for the economic component of the evaluation and to undertake statistical tests for differences in cost or cost-effectiveness. This paper discusses the current methodological issues surrounding stochastic measurement in clinical trials, discusses the additional issues raised by the assessment of economic and quality-of-life outcomes and specifies the challenges facing economists if they are to answer the questions now being posed about economic analysis by statisticians and clinical researchers. It is concluded that application of the standard principles of statistical inference to economic data is not straightforward and will require value judgements to be made about statistical significance and economic importance, which may differ from those already made in purely clinical studies.

Confidence Intervals↗
PubMed1993

Immunogold localization of porcine oviductal secretory proteins within the zona pellucida, perivitelline space, and plasma membrane of oviductal and uterine oocytes and early embryos.

The objectives of the present study were to develop an antibody probe to the porcine estrogen-dependent oviductal glycoproteins and to determine, by use of immunogold electron microscopy, whether these glycoproteins become associated with oviductal and uterine oocytes and early embryos. Polyclonal antibody, prepared using the M(r) 75,000-85,000 glycoprotein, separated from other proteins by two-dimensional SDS-PAGE, specifically recognized all three estrogen-dependent glycoproteins (acidic 75,000-85,000 M(r); acidic 100,000 M(r); basic 100,000 M(r)). In ampullary tissue collected from ovariectomized and estrogen-treated gilts and from gilts at Day 1 of estrus, gold particles were clustered over putative secretory granules restricted to the apical region of secretory epithelial cells. While follicular oocytes did not react with immunoreactive colloidal gold, oviductal and uterine unfertilized oocytes were found to be densely and uniformly labeled by colloidal gold throughout the zona pellucida, associated with flocculent material in the perivitelline space, and associated with microvilli and vitelline membrane. Similarly, in oviductal (1-4-cell) and unhatched uterine (4-cell/blastocyst) embryos, colloidal gold particles were distributed throughout the zona pellucida, heavily associated with flocculent material in the perivitelline space, and associated with the plasma membrane of the blastomeres. Immunoreactive colloidal gold remained detectable within Day 7 hatched uterine embryos, but not with embryos from later days. These results further support the proposal that porcine estrogen-dependent oviductal glycoproteins are released into the oviductal lumen, become associated with oviductal and uterine oocytes and early embryos, and are retained by oocytes and early embryos in the uterus.

Animals↗
PubMed1993

Unwritten knowledge in nursing: consider the spoken as well as the written word.

Knowledge has been defined as familiarity gained by experience or a person's range of information and theoretical understanding (Sykes, 1982). The distinction is made to avoid confusion with the knowledge of scientism (Bullock, Stallybrass, & Trombley, 1988), where true or factual knowledge is held to be derivable only from the inductive methods of the natural sciences. Knowledge has its origins in a broader field of understanding than that of empirical measurement.

Cognition↗
PubMed1993

Effect of butter, mono- and polyunsaturated fatty acid-enriched butter, trans fatty acid margarine, and zero trans fatty acid margarine on serum lipids and lipoproteins in healthy men.

The effect of diets containing 50% of fat calories from butter, butter enriched with mono- and polyunsaturated fatty acids, and margarines with and without trans fatty acids on the serum lipids of 38 healthy men in a free-living condition have been determined. Serum lipid responses to the high level of individual dietary fats were unexpectedly small. The butter diet produced a small, but significant rise (5%) in the total serum cholesterol and low density lipoprotein (LDL)-cholesterol, relative to all other diets. Enrichment of butter with either olive oil (50/50) or sunflower oil (50/50) failed to reduce serum lipid levels below habitual diet values. Hard margarine, containing 29% trans fatty acids, caused a decrease in apolipoprotein A-I and B levels, but did not change total serum cholesterol or LDL-cholesterol levels, relative to habitual diet values. A soft margarine, high in linoleate, with no trans fatty acids reduced total cholesterol, LDL-cholesterol, and apolipoprotein B significantly, relative to all diets. Soft margarine high density lipoprotein (HDL)-cholesterol levels remained unchanged, but apolipoprotein A-I values were decreased relative to habitual and butter diets. The quantities of saturated fatty acids and the sum of monounsaturated and polyunsaturated fatty acids consumed on the hard and soft margarines were equal; therefore, the different response of serum cholesterol and LDL-cholesterol between these two diets is attributable to the trans fatty acids in the hard margarine. The data indicate that trans fatty acids are not metabolically equivalent to the natural cis isomers and that they affect the serum lipid profile adversely.

Adult↗
PubMed1992

Beyond empathy: expanding expressions of caring.

In this paper, a model describing nurses' responses to patients who are suffering is presented. The nurse's level of engagement with the patient is affected by whether the caregiver is focused on him-/herself or on the sufferer (i.e. embodied with the patient) and whether the caregiver is responding reflexively or with a learned response. Four types of communication patterns are identified: engaged responses (first-level) are used in a connected relationship; when the nurse responses reflexively and is focused on him-/herself, the response is reflected; when the caregiver is patient-focused, a learned response is labelled a professional response; and a self-focused, learned response is labelled detached. Examples of each type of response are provided.

Communication↗
PubMed1992

Nausea and vomiting during pregnancy: effects on the quality of women's lives.

More than 70 percent of all pregnant women experience nausea and vomiting during pregnancy, and 28 percent report that symptoms cause them to change their usual activities. We investigated the magnitude of problems that nausea and vomiting impose on the lifestyle of pregnant women and their families. Twenty-seven women who were experiencing different degrees of nausea and vomiting were selected from 147 pregnant women and asked to participate in semistructured telephone interviews. All participants reported changes in family, social, or occupational functioning as a result of these symptoms. Nausea and vomiting can impose substantial lifestyle limitations on pregnant women that can have short- and long-term consequences for them and their families. Both the duration and severity of symptoms were greater for many participants than is generally believed. All participants reported that recumbent rest or dietary alterations provided relief. Caregivers should recognize and validate the need for pregnant women to make changes in lifestyle that will enable them to achieve comfort.

Adult↗
PubMed1992

Exploring empathy: a conceptual fit for nursing practice?

After three decades, the efficacy of empathy in the clinical setting remains undocumented. Recently, concerns have been raised that the concept may be inappropriate and even harmful to the nurse-patient relationship. An analysis of the concept indicates that empathy consists of moral, emotive, cognitive and behavioral components. By tracing the integration of this concept into nursing, we suggest that empathy was uncritically adopted from psychology and is actually a poor fit for the clinical reality of nursing practice. Other communication strategies presently devalued, such as sympathy, pity, consolation, compassion and commiseration, need to be reexamined and may be more appropriate than empathy during certain phases of the illness experience. Directions for future research are suggested.

Behavior↗
PubMed1990

Outcome assessment in cardiovascular cost-benefit studies.

The scarcity of health resources and development of new treatments have introduced a need to assess health care interventions in the areas of both costs and benefits. Information on costs and benefits of one treatment program relative to another can assist decisions about resource allocation by indicating which interventions offer the greatest benefit at the least cost. Economic evaluation is dependent on accurate definition and appropriate measurement of outcome or benefit. This article reviews a number of evaluation techniques and cost-benefit studies associated with cardiovascular medicine. The focus is on health-related quality of life, the methodology, and the problems encountered therein. Methods for combining quantity and quality of life are discussed with reference to a composite measure of health outcome, quality-adjusted life years.

Cardiac Rehabilitation↗
PubMed1990

Jokes and reassurance are not enough: ways in which nurses relate through conversation with elderly clients.

An ethnographic study was conducted into the style of conversation registered nurses used with elderly residents during activities of morning care. Speech was analysed into basic components of speech act categories (e.g. explanation, instruction, reassurance). Patterns of speech style were seen to vary in relation to the physical procedure being carried out, and to function as an adjunct to the smooth execution of this physical activity. However, they were also seen to have an important psychological function reflecting a particular way of relating. Some morning-care activities--the journey--were associated with a more personally engaging social interaction which appeared to be mutually beneficial to nurse and resident. Other approaches to morning care--the dissection--appeared to constrain the way the nurse interacted, producing a more formal style of relating. Findings were discussed in terms of optimal use of physical activities of nursing care to achieve greatest benefit in relation to the psychological needs of the resident, as addressed through verbal interaction.

Aged↗
PubMed1989

Safety of intravenous ciprofloxacin. A review.

Data from 1,878 courses of intravenous ciprofloxacin therapy, administered to 1,869 patients in 59 clinical trials, were analyzed for drug safety. The 985 men and 884 women had a mean age of 50 years, and more than one third were over 60 years of age. An overwhelming majority had at least one accompanying systemic illness, and the condition of more than half the patients was only fair or poor at the onset of therapy. Ciprofloxacin was administered in a unit dose of either 200 mg (68 percent of the patients) or 300 mg (28 percent) by intravenous infusion, generally over 30 minutes every 12 hours, at a mean daily dosage of 456 mg. The duration of intravenous therapy ranged from one to 57 days, with a mean of seven days; over 1,000 patients were treated for more than five days. Adverse events considered probably or possibly related to intravenous ciprofloxacin were reported in 15.8 percent of the courses; therapy was discontinued prematurely in 3 percent. Local reactions at the site of infusion were the most common, occurring in 4.4 percent of the courses. Changes in blood chemistry values (4.1 percent) included increases in alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase. Reports of adverse effects referable to the gastrointestinal tract (3.0 percent) were primarily nausea and diarrhea. Central nervous system reactions (1.8 percent) included convulsive seizures, headache, and dizziness. In comparative trials, events considered probably or possibly drug related were reported for 17.3 and 13.6 percent of the ciprofloxacin- and ceftazidime-treated patients, respectively. The incidence of adverse events other than local reactions at the infusion site was not significantly different between the ciprofloxacin- and ceftazidime-treated patients (12.7 percent versus 11.0 percent, p greater than 0.2).

Administration, Oral↗
PubMed1989

The effect of patient charges on the utilisation of prescription medicines.

This study is a time-series regression analysis of National Health Service (NHS) prescription drug utilisation. The monthly volume of items dispensed with and without charge in England (1969-1986) form the dependent variables for model estimation. The main finding is that, for items that incur a charge, increases in the real value of the prescription charge are associated with reductions in prescription drug utilisation. The charge-volume elasticity (1969-1986) is estimated at -0.33, rising to -0.64 in the later sub-period (1978-1986). OTC products display a positive cross-price elasticity (+0.22) with chargeable items, but they are less clearly substitutes for prescriptions exempt from charge. One of the main predictors for exempt prescriptions is the number of elderly in the population. The study concludes that the evaluation of the prescription charge policy requires more detailed study of both the incidence of the charge effect and the possible costs and health consequences of reduced utilisation due to the charge.

Demography↗