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Biomedical subjects

D Field

Publications and source records attributed to D Field.

At least 19 recordsLinked to original sources
PubMed1992

The routinization of hospice: charisma and bureaucratization.

In 25 years the number of hospices in Britain has multiplied from under 15 in 1965 to over 430 in 1991. During this period, often working out with the mainstream health system, the hospices actively sought to transform terminal care. More recently a process of diversification and legitimation has meant that hospices have become increasingly subject to mainstream influence. Using Weber's concept of charisma we examine the development of the hospice movement during this period of expansion. We suggest there are a number of factors leading to the routinization of hospice care including the ways in which it was sponsored and developed at the local level, and pressures toward bureaucratization and professionalization. We make links with recent developments in the health services. Finally we consider whether it is possible for the hospice movement to sustain its founding ideals.

Hospices↗
PubMed1992

Communication with dying patients in coronary care units.

There now seems to be a much greater willingness among hospital staff to disclose a terminal prognosis to a patient. The paper starts with a review of the changing attitudes towards disclosure and then considers communication with dying patients in Coronary Care Units. After considering general factors influencing nurse communication with dying patients sources of difficulty in such communication are considered. Characteristics of patients and relatives, of nurses, and features of the work environment may all contribute to communicational difficulties. The paper closes with a brief overview of basic communicative requirements.

Cardiovascular Diseases↗
PubMed1992

Pain: a kaleidoscope of ideas, concepts and approaches.

The following pages contain summaries and short statements on chronic pain providing further material for reflection and debate, namely: a) synopses of recent findings on: the physiology and biochemistry of pain; the contribution of psychoneuroimmunology; b) some views on a sociology of pain; c) analysis of various concepts and approaches which consider pain as: a symptom of disease a form of behaviour a psychosomatic reaction and a social learning process a communication phenomenon a symptom of disintegrated life a disruption in the integrity of the system a signal of broken unity a breach in the wholeness of the individual; d) a holistic approach in pain therapy; e) some unanswered questions.

Chronic Disease↗
PubMed1991

Continuity and change in personality in old age--evidence from five longitudinal studies: introduction to a special issue.

This short essay introduces some of the current problems in developmental personality theory and comments on the five articles that follow, all of which arise from longitudinal studies of aging in Israel, Sweden, and the United States. Although the study of personality has always been of central interest in psychology, personality development in advanced old age is a very new topic. We hope that this Special Issue will stimulate a lively discussion and will provoke further studies of personality in old age, which is indeed a "special issue."

Aged↗
PubMed1991

Personality in advanced old age: continuity or change?

A longitudinal study of elderly persons found evidence of personality development even in advanced old age. Five traits, similar to traits found in younger persons, were identified. Although considerable continuity was found, change also was apparent. An increase in agreeableness was observed for the old-old, bringing their scores up to the level maintained by the oldest-old. Two traits were stable: satisfaction (65% did not change reliably) and intellect (63% did not change reliably). A decline in extraversion occurred in both age groups. Energetic, in which 40% declined, may be more affected than the other traits by external, environmental circumstances. The study confirms the findings of longitudinal studies of children and younger adults and extends them into the final stages of life.

Age Factors↗
PubMed1991

Development of a clinical measure of postural control for assessment of adaptive seating in children with neuromotor disabilities.

The primary purposes of this article are to review the literature on seating assessment and to describe the development of a clinical evaluation scale, the Seated Postural Control Measure (SPCM), for use with children requiring adaptive seating systems. The SPCM is an observational scale of 22 seated postural alignment items and 12 functional movement items, each scored on a four-point, criterion-referenced scale. A secondary purpose of this article is to report the reliability of the seven-point Level of Sitting Scale (LSS). Interrater and test-retest reliability of the SPCM items and the one-item LSS were evaluated on a sample of 40 children with developmental disabilities who sat with and without their seating systems. Kappa values of .75 or higher were considered excellent, .40 to .74 as fair to good, and less than .40 as poor. The interrater reliability tests for the two seated conditions and the two test sessions conducted 3 weeks apart yielded overall item Kappa coefficient means of .45 for the alignment section and .85 for the function section. Test-retest results for the SPCM items were less satisfactory, with item Kappa coefficient means for the two seating conditions and raters of .35 and .29 for alignment and function, respectively. Reliability results did not appear to be consistently better among seating conditions, raters, or test sessions. Kappa coefficients for the LSS were fair to good for both interrater and test-retest reliability. Plans for future development of the SPCM and LSS are discussed.

Adolescent↗
PubMed1991

Fear of death and strategies for coping with patient death among medical trainees.

This paper describes a longitudinal study of fear of death following up fourth-year medical students in their junior house officer year. It confirms previous findings that the fear of death is and remains multidimensional, with fear of being dead having the lowest score on both occasions and fear of someone close dying being consistently the highest. Fear of death reduces on each dimension over time, though not significantly. An analysis of descriptions of strategies used by students to cope with patient death showed that passive acceptance through rationalizing was the most commonly used, especially by men, followed by supporting the patient emotionally or clinically, which was used especially by women. The highest fear and stress scores were associated with avoidance, dismissal and seeking advice, while the lowest were shown by those who rationalized the event. The paper goes on to describe the relationship of fear of death to various individual differences including empathy, gender, parental death, parental anxiety, and stress.

Adaptation, Psychological↗
PubMed1991

Survival and place of treatment after premature delivery.

In a one year prospective study in the Trent region we examined the short term outcome (survival to discharge) of all infants who required admission to a baby care unit. Infants of less than or equal to 28 weeks' gestation who received all their perinatal care in one of five large centres (each providing more than 600 ventilator days/year) showed significantly better survival rates than infants electively treated throughout their entire course at one of the 12 smaller units (34 survivors from 65 infants (52%) compared with eight survivors from 37 infants (22%). These differences occurred despite the elective transfer of many of the sickest infants from the smaller units to the larger. Differences in survival between more mature infants were not significant. These results support the policy that there should be a more centralised neonatal service for those infants at or below 28 weeks' gestation.

Birth Weight↗
PubMed1990

A crying baby.

Explore the source record for details and available documents.

Adult↗
PubMed1990

Human discrimination of fractal images.

In order to transmit information in images efficiently, the visual system should be tuned to the statistical structure of the ensemble of images that it sees. Several authors have suggested that the ensemble of natural images exhibits fractal behavior and, therefore, has a power spectrum that drops off proportionally to 1/f beta (2 less than beta less than 4). In this paper we investigate the question of which value of the exponent beta describes the power spectrum of the ensemble of images to which the visual system is optimally tuned. An experiment in which subjects were asked to discriminate randomly generated noise textures based on their spectral drop-off was used. Whereas the discrimination-threshold function of an ideal observer was flat for different spectral drop-offs, human observers showed a broad peak in sensitivity for 2.8 less than beta less than 3.6. The results are consistent with, but do not provide direct evidence for, the theory that the visual system is tuned to an ensemble of images with Markov statistics.

Computer Simulation↗
PubMed1989

Inspiratory-to-expiratory ratio during ventilation for idiopathic respiratory distress syndrome.

We have studied the effects of changes in inspiratory-to-expiratory ratios (I/E ratios) on transcutaneous blood gases in a group of 30 infants receiving respiratory support for the idiopathic respiratory distress syndrome (IRDS). Following the use of a reversed I/E ratio (inspiration exceeding expiration), changes in oxygenation were very variable but improvements were seen most consistently in babies weighing greater than 1,750 g and less than 850 g. The use of reversed I/E ratios seemed less efficient than positive end-expiratory pressure in raising TcPO2 for the same increase in mean airway pressure. Changes from a 1:1 ratio to a normal I/E ratio, in which expiratory time exceeded inspiratory time by 50-100%, led to more marked and consistent falls in TcPO2. We conclude that a flexible attitude toward the use of I/E ratios should be adopted to avoid raising mean airway pressure needlessly.

Animals↗
PubMed1989

Nurse's accounts of nursing the terminally ill on a coronary care unit.

This paper is based on nurses' reported experiences about nursing people dying in a coronary care unit, and their attitudes towards such work. Two patterns of dying associated with cardiac arrest and cardiac failure were typical in the unit, each with its difficulties and problems. However, the nurses did not report any severe coping difficulties associated with their nursing care of dying patients. Their most severe difficulties were those relating to telling relatives about a patient's death. Elements within the unit's ethos and organisation associated with this positive coping were the high staff-patient ratio, low staff turnover, good and supportive relationships among staff, and the policy of open and honest communication about prognosis. Of particular importance was the feeling that everything that it was possible to have done for the patient had been done.

Adaptation, Psychological↗
PubMed1989

Cerebral haemodynamic effects of changes in positive end expiratory pressure in preterm infants.

The effects of changes in positive end expiratory pressure (PEEP) on cerebral blood flow velocity, arterial blood gases, and mean arterial pressure were studied in newborn infants. In mechanically ventilated premature infants with severe respiratory disease, an increase in PEEP from 2 to 6 cm H2O was associated with an increase in cerebral blood flow velocity. There was no significant change in mean arterial blood pressure. There was a significant increase in PaO2 and PaCO2 for every stepwise rise in PEEP. Multivariate regression analysis showed that 72% of the effect on cerebral blood flow velocity was attributable to PaCO2 alone and that any change in blood pressure was not likely to contribute to these changes. There was no evidence that changes in PEEP within the commonly used range adversely affected the neonatal cardiovascular or cerebral circulations.

Blood Flow Velocity↗
PubMed1988

Continuity in intellectual functioning: the role of self-reported health.

Surviving members of the Berkeley Older Generation Study were interviewed and tested with the Wechsler Adult Intelligence Scale in 1969-1970 and again in 1983-1984, when subjects' ages ranged from 73 to 93. Health was assessed by self-reports at both measurement periods. Although many individuals showed some decline in intellectual functioning, substantial individual differences were apparent at all age levels. More than one half of the subjects showed no reliable change, and a minority showed a reliable increase in verbal scores. The role of self-reported health has increasing importance in the maintenance of intellectual functioning in advanced old age.

Aged↗
PubMed1988

Continuity and change in social support between young-old and old-old or very-old age.

This longitudinal research examined continuity and change in social support in a sample of 74 old-old (74 to 84) or very-old (85 and over) members of the Berkeley Older Generation Study. Considerable continuity in extent of contact was found between 1969 and 1983 for the group as a whole, particularly with respect to family relationships. In beyond-family contacts, declines were observed for men but not women, and for the very-old but not the old-old. Important changes also were observed in involvement or subjective level of commitment: satisfaction with children increased, while involvement beyond the family declined.

Adult↗
PubMed1988

Teaching sociology in UK medical schools.

This paper briefly reviews the development of the teaching of sociology in UK medical schools, and then discusses some of the problems associated with such teaching.

Attitude of Health Personnel↗