Biomedical subjects
Publications and source records attributed to C A Holmes.
Holism is a turbid, amorphic term, of Quixotic character, the meaning of which alters according to the context in which it is located. Coming to grips with holism has been likened to trying to hold ice, because it disappears in the attempt. This paper assesses the variety of meanings attached to the term, and the extent to which the distinctive features of holism have melted away in the hands of nursing.
Using an in vitro cadaveric femoral neck osteotomy model and a paired experimental design, we compared fixation stiffness and yield load for three- and four-pin configurations for both Knowles pins and Asnis screws and for three Asnis screws versus an AO-ASIF sliding hip screw. Repeat measure analyses of variance indicated a significant increase in stiffness (p < 0.05) with the use of three versus four pins; the yield load did not depend significantly on the number of pins. Fixation was significantly stiffer (p < 0.01) and stronger (p = 0.02) for Knowles pins if the osteotomy was oblique rather than transverse to the femoral neck; the opposite was found for Asnis screws. Femoral fixed with hip screws were significantly stiffer (p < 0.01) than the contralateral side fixed with three Asnis screws. No significant difference in yield load was observed, however. Clinically, it appears from these findings that the use of three Asnis screws or three Knowles pins provides modest increases (averaging 4%) in fixation stiffness with no degradation in strength when compared with four screws or pins. Parallel placement of Asnis screws also provides advantages over nonparallel Knowles pins by allowing controlled impaction of the femoral head. While three Asnis screws provide fixation stiffness approximately 40% less than that found with a sliding hip screw, there is no compromise in fixation strength.
Examines the political and ideological significance of measures of quality of life, specifically Quality Adjusted Life Years (QALYs). Briefly reviews recent developments in the debate surrounding the economic and political functions of quality of life measures. The dialectic between conceptions of the quality of life and the implicit realpolitik of socio-economic pressures, ecological conditions, political ethos and cultural norms and expectations, is conceived as a powerful means for the critique of our aspirations concerning health. Argues that existing approaches to assessing quality of life, in denying this dialectic, have jeopardized their potential contribution to the planning, implementation and evaluation of health are policy. Resource allocation challenges us to develop openly ideological strategies and measures.
This paper offers a case study in the depoliticization of the concept of praxis as it enters the nursing literature through Margaret Newman's (1990) paper Theory of Health as Praxis, which draws on Lather's (1986) description of 'research as praxis.' Newman's view of the relationship between consciousness and matter is contrasted with that of Marxism and her concept of health-illness is discussed. These considerations yield some examples of the liberal-democratic ideological position which underwrites her theory, and it is suggested that in drawing on the notion of praxis, Newman borrows from an ideology which is ultimately at odds with her theoretical construction of nursing.
This exploratory paper considers a few possibilities for conceiving nursing as a form of aesthetic praxis. More specifically, drawing on the works of Erving Goffman on dramaturgy, and Elizabeth Burns on theatre, it makes some suggestions concerning nursing as a form of dramatic performance, and briefly attempts to relate this to concepts of praxis drawn from the writings of Hannah Arendt and critical social theorists. In contrast to Goffman's dramaturgy, which stresses the artifice of social relations and suggests a cynical view of human interactions, a critical theory of dramatic praxis introduces a normative dimension in which performance may become self-realizing and emancipatory as it aspires to the status of aesthetic praxis. Conceived in such terms, nursing practice becomes a powerful form of self-expression which has the potential to become liberating for the nurse and the patient.
Taken together, studies of seroconversion, exposure incidents, and compliance with Universal Precautions Policy help researchers understand the risks to health care workers of occupationally acquired HIV infection. The seroconversion studies show that the risk of infection is low (1 in 250) even when the incident is a percutaneous exposure to blood from a known HIV-positive patient. When the exposure is to blood from a patient whose HIV-status is unknown, or if the exposure is not through the skin, or if the exposure is to a body substance other than blood, the risk is considerably lower. The studies of exposure incidents show that for most health care workers, percutaneous exposures to blood are infrequent. Studies of compliance with Universal Precautions Policy show that exposure incidents that do occur can be prevented nearly half the time. The risk of patient-to-provider transmission of HIV is small but not completely negligible. This small risk can be made even smaller by adhering to recommended infection control guidelines, but it cannot be eliminated completely. Although most health care workers enter the medical field accepting that their work may expose them to infectious agents, there is still a desire for risk-free practice. Achieving an entirely risk-free practice is probably impossible; it is certainly not within reach today. For the foreseeable future, the only reasonable course is to fully understand the risks, to enter into practice psychologically prepared to accept these risks, and to practice in a way that minimizes exposures without compromising patient care.
Between September 1990 and January 1991, while deployed to the Persian Gulf for Operation Desert Shield, 118 patients underwent arthroscopic surgery of the knee on the U.S. Naval Hospital Ships USNS Mercy and USNS Comfort. There were 113 men and 5 women, with an average age of 28 years (range, 19-59 years). The most common findings at the time of arthroscopy were meniscus tears (53%), anterior cruciate ligament tears (29%), and normal arthroscopic examinations (9%). There were three complications, two hemarthroses and one superficial portal site infection. Seventy patients (59%) were able to be returned to duty at an average of 6 days post-operatively, obviating the need to evacuate these patients out of the Middle East theater to Europe or the United States, thus avoiding additional delay, expense, and loss of the service member to his military unit.
Although the concept of psychopathy retains its currency in British psychiatry, apparently being meaningful as well as useful to practitioners (1), it is often taken to refer to a purely legal category with social control functions rather than a medical diagnosis with treatment implications. I wish, in this brief article, to suggest that it is essentially, and most usefully, an ethical category which stands outside the diagnostic framework of present-day psychiatry.
The underlying philosophical assumptions associated with the current vogue for humanistic and holistic approaches to nursing have not been subjected to systematic scrutiny, laying nursing open to the charge of being anti-scientific and even irrational. This paper outlines some of these assumptions and their origins, and proceeds to a brief survey of their impact on nursing theory, education and practice. It concludes with a call for the elucidation and consolidation of nursing practice which reflects phenomenological and humanistic alternatives to the natural science principles which have characterized traditional medical practice. In this connection I have used the term 'positivism' to refer to a general orientation according to which the world can only be known through observable entities, and regularities may be demonstrated and general laws verified through their measurement and quantification.
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An important component in the development of any educational program is the evaluation of its effectiveness. The program described in this article was designed in such a way that its impact on practitioners' knowledge, attitudes, and clinical practices regarding human immunodeficiency virus (HIV) could be evaluated. One hundred ten participants were asked to complete pre-conference and post-conference tests in order to measure improvement that resulted from program attendance. The author presents both a description of the conference and a summary of the evaluation results, along with suggestions for improving future educational programs.
In order to assess the need for acquired immunodeficiency syndrome education among podiatric assistants, comprehensive questionnaires on human immunodeficiency virus infection were distributed in February and March 1989. The findings presented here are based upon questionnaires completed and returned by 300 assistants. The purpose of the needs assessment was three-fold: to find out how much the surveyed assistants know about AIDS and HIV infection, how they feel about working with HIV-infected patients, and to what extent they understand and follow recommended infection control practices. The results of the survey reveal that many of the assistants in the sample in this study are ill-informed about HIV infection, that they have numerous concerns and fears about working with HIV-infected patients, and that they are not following recommended infection control guidelines.
The increasing requirement for evaluation of health care, either for purposes of quality assurance or deciding resource distribution issues, has brought into question a number of ideas concerning the aims of the health care enterprise. This article suggests that the ultimate aim is to improve the quality of life, and examines the feasibility of adopting this as an evaluation criterion. Difficulties concerning the concept and definition of the quality of life are outlined, and a plea made for the adoption of the broadest possible therapeutic aims. Social indicators and subjective evaluations are considered in turn as measures of the quality of life, and their inadequacies and strengths exposed. Relationships between the measures are discussed, and their uses outlined. It is finally suggested that nurses should participate in the formulation of quality of life concepts and evaluations which reflect the values which underpin their own practice.
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