Biomedical subjects
Publications and source records attributed to Colin Jones.
As the case study approach gains popularity in nursing research, questions arise with regard to what it exactly is, and where it appears to fit paradigmatically. Is it a method, a design, are such distinctions important? Colin Jones and Christina Lyons review some of the key issues, with specific emphasis on the use of case study within an interpretevist philosophy.
The experience of being critically ill and being a patient in a critical care unit has attracted considerable research interest in recent years. Evidence of this is apparent in the increasing development of critical care follow-up services in many of our hospitals in the United Kingdom. However, actually conducting research this area can be fraught with difficulties and problems. Research participants may be extremely vulnerable during their recovery, making the methodological considerations crucial, in any study, which aims to explore the experiences of survivors. This paper explores some of the difficulties the researcher can face when researching this area.
PURPOSE: To compare the rate of retinal detachment in a group of patients treated with intravitreal ganciclovir to the rate of retinal detachment in a group of patients treated with systemic ganciclovir. METHODS: A retrospective non-randomized comparative case series was conducted. The participants were 186 consecutive patients with cytomegalovirus (CMV) retinitis treated at two centres over the period from June 1990 to May 1997. Of the 186, 133 patients had systemic therapy of whom 113 had intravenous ganciclovir or foscarnet and 20 had oral ganciclovir, and 53 patients had intravitreal induction and maintenance therapy. The main outcome measure was the rate of retinal detachment, which was calculated using person-months-at-risk denominators. The effect measure used in the main comparative analysis was the hazard ratio obtained from multiple regression using the Cox proportional hazards model. RESULTS: Retinal detachment occurred in three of 53 patients in the intravitreal therapy group, one of 20 patients receiving oral maintenance therapy and 21 of 113 patients receiving intravenous maintenance therapy. The risk of retinal detachment with systemic therapy was 14-fold higher than with intravitreal therapy (P < 0.001)and up to fourfold higher with oral maintenance therapy. CONCLUSIONS: Intravitreal therapy offers a significant advantage over systemic therapy in the treatment of CMV retinitis by substantially reducing the risk of CMV-related retinal detachment.
Surviving events that have posed a serious threat to life can result in major psychological problems during the recovery period. Younger patients, with years of life ahead of them, are at risk of depression and loss of self-esteem following their ordeal, despite their physical recovery. Traditional forms of counselling and psychotherapy following traumatic events can sometimes carry a stigma and be viewed as 'disease centred'. Reminiscence and life review therapies, used until now, with the elderly, appear to have valuable transferable benefits to younger survivors of critical illness. Life review and reminiscent interventions are holistic and person centred, techniques resonating with the essence of critical care nursing. Life review and reminiscence can be used therapeutically from an early stage to help minimize the negative psychological effects of being critically ill.
Clinical experience tells us that the activity of 'putting the house in order' as patients reach the terminal stage in their illness is both a common and legitimate exercise. This process can entail many activities, both physical and emotional. For example, arranging financial affairs, making a will, compiling a living will, organizing their own funeral, completing unfinished emotional business, and perhaps most importantly, pondering the very meaning of life itself. In a continual search to find innovative ways of supporting those who are touched by death and dying, this article will discuss how narrative therapeutic approaches could be helpful in supporting the family of a terminally ill patient who is 'putting the house in order'. Incorporated within this specialist area are perceptions of death and dying, theories of death and dying as well as emotions and the search for meaning. Also under review will be the evidence base for psychotherapeutic interventions, and a review of the narrative therapy approach.