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Biomedical subjects

D Gould

Publications and source records attributed to D Gould.

At least 37 records · Page 2Linked to original sources
PubMed2000

Scleral outfolding for macular translocation.

PURPOSE: To report experimental study and clinical observation of scleral outfolding for macular translocation. METHODS: In six human cadaver eyes, circumferential mattress sutures to create sclera infoldings were compared with radial-interrupted mattress sutures to create scleral outfoldings. In a 75-year-old man with macular degeneration and choroidal neovascular membrane, radial-interrupted mattress sutures were used for macular translocation. RESULTS: In the human cadaver eyes, circumferential mattress sutures for scleral infolding created an average decrease in corresponding internal anteroposterior retinal contour of 0.36 mm. Radial-interrupted mattress sutures for scleral outfoldings created an average decrease in the corresponding internal anteroposterior retinal contour of 4. 61 mm. The statistical significance of the difference between infoldings of the sclera versus outfoldings of the sclera had a P value of.0001. CONCLUSIONS: Initial experimental and clinical study suggests that radial-interrupted mattress sutures may generate more shortening of the internal scleral surface and greater macular translocation than circumferential mattress sutures. Additional studies are needed to evaluate the long-term effects of radial-interrupted mattress sutures and macular translocation for treatment of subfoveal choroidal neovascularization secondary to age-related macular degeneration.

Aged↗
PubMed2000

Immuno- and genetic therapy in autoimmune diseases.

Animal models of autoimmune disease have been developed that mimic some aspects of the pathophysiology of human disease. These models have increased our understanding of possible mechanisms of pathogenesis at the molecular and cellular level and have been important in the testing, development and validation of new immunotherapies. The susceptibility to develop disease in the majority of these models is polygenic as is the case in humans. The exceptions to this rule are gene knock outs and transgenic models of particular genes which, in particular genetic backgrounds, have also contributed to the understanding of single gene function and their possible contribution to pathogenesis. Gene therapy approaches that target immune functions are being developed with encouraging results, despite the polygenic nature of these diseases. Basically this novel immuno-genetic therapy harnesses the knowledge of immunology with the myriad of biotechnological breakthroughs in vector design and delivery. Autoimmune disease is the result of genetic dysregulation which could be controlled by gene therapy. Here we summarize the genetic basis of these human diseases as well as some of the best characterized murine models. We discuss the strategies for their treatment using immuno- and gene therapy.

Animals↗
PubMed2000

The role of the haemoglobinopathy nurse counsellor: an exploratory study.

The haemoglobin disorders are among the most common genetically inherited conditions within the United Kingdom. Individuals who are fully affected have severely impaired health while carriers may be faced with difficult reproductive decisions although generally they are well. Policy makers agree that counselling for families at risk should be undertaken in primary care settings and since the early 1980s this service has been undertaken mainly by specialist haemoglobinopathy nurse counsellors. Despite a number of government reports and recommendations for best practice, problems with service provision continue to be highlighted. However, there is little documented information about the work undertaken by the counsellors or how they perceive their role. A descriptive study was therefore conducted to fill this gap. It took the form of a questionnaire survey undertaken with 26 counsellors. The results were analysed by content and used to develop an interview schedule which was employed to obtain more detailed information from staff in four centres. The counsellors suggested that most of their time was spent in client-centred activities and most clients were first seen antenatally. However, there were significant barriers which prevented optimal service provision. These included: problems of communication with other health professionals, obtaining laboratory results crucial to the early identification of couples at risk, late referral from general practitioners and poor facilities for administration, especially maintaining computer databases essential for record keeping. Developing and obtaining written information suitable for families was particularly time-consuming.

Clinical Competence↗
PubMed2000

Normal labour: a concept analysis.

Midwives practice within the normal childbirth paradigm. It is argued that midwives failure to define normality has allowed increasing technicalization and medicalization of the normal physiological process of birth because doctors so closely define abnormality. A concept analysis model is used to clarify what is meant by the term 'normal labour'; the emphasis being on understanding what normal labour is as it applies to midwifery practice today. This analysis highlights the importance of movement and the sequential nature of normal labour, and reveals how this is implicit within the other uses of both the words normal and labour. The final definition of normal labour offered is intended to be complimentary to existing medical determinants of progress of normal labour, because as the body of the text stresses, medical knowledge is fundamentally enmeshed in midwifery care.

Female↗
PubMed2000

Improving hand hygiene in community healthcare settings: the impact of research and clinical collaboration.

Observation of nursing activities and bacteriological studies undertaken with a sample of nurses employed in a community NHS trust indicated that considerable scope for cross infection existed during domiciliary visits. Poor conditions in patients' homes compromised nurses' ability to perform hand hygiene effectively, increasing risks. A clinical trial indicated that carriage of medically significant bacteria likely to contribute to cross infection could be reduced by applying an antiseptic cream which exhibited residual effectiveness. An audit of hand hygiene throughout the inner city trust indicated the need to pay greater attention to hand hygiene, especially during home nursing visits. The situation was less acute in a rural trust where a second audit was performed for comparative purposes. The motivation of clinical staff to improve hand hygiene precautions was high.

Anti-Infective Agents, Local↗
PubMed2000

Intervention studies to reduce the prevalence and incidence of pressure sores: a literature review.

Much has been written about the prevention of pressure sores. However, electronic and manual searches located only 10 studies within the literature in the UK that described interventions able to reduce either their incidence or prevalence. All the studies located contained serious methodological flaws. Apparent success in reducing the number or severity of pressure sores could have resulted because staff involved in data collection were aware that the study was being undertaken and thus took more interest in pressure area care. From the review findings it is apparent that there is a dearth of research evidence upon which to base practice in the sphere of pressure sore prevention and further research is urgently required.

Humans↗
PubMed2000

Evaluating support surfaces for patients in transit through the accident and emergency department.

Little attention has been given to pressure area care for patients admitted via the accident and emergency department (A & E) in UK hospitals, despite evidence that they may wait for considerable periods on hard surfaces, placing them at risk of tissue damage. The literature was searched, and in the absence of existing guidelines to evaluate the suitability of the standard hospital trolley for use with emergency admission patients, criteria were developed by consensus among stakeholders with relevant expertise who were employed in an acute NHS hospital trust. Audit of the existing patient support surfaces using these criteria revealed deficiencies in all of them. Some of the problems identified were related to deterioration of the equipment; others were related to its design. The criteria were used to inform the purchase of new equipment, and a system of auditing to improve pressure area care for emergency admission patients has been established in the trust. The initiative has also drawn attention to significant omissions in the literature relating to pressure area care, including the need to evaluate patient comfort and inclusion of consumer views.

Acute Disease↗
PubMed2000

Updating cardiopulmonary resuscitation skills: a study to examine the efficacy of self-instruction on nurses' competence.

Nurses' competence in cardiopulmonary resuscitation (CPR) has been shown to be consistently poor over the past decade. Studies have suggested that CPR teaching methods need to be evaluated and refined in order to improve practice. Self-instruction has been suggested as one alternative to formal retraining programmes, but has not been evaluated with respect to nurses in the UK. A quasi-experimental design utilizing random allocation of matched subjects to one experimental and two control groups was adopted with a sample of 20 undergraduate nursing students. The subjects' CPR ability was assessed concurrently using a resuscitation manikin and an observational checklist. Subjects undertaking self-instruction produced significantly (P < 0.05) higher ability scores than those who did not participate in retraining. The time spent in self-instruction was evaluated positively by the students. The results are discussed in the light of previous research and current recommendations for regular CPR updating by all clinical nurses.

Adult↗
PubMed2000

Activation of cutaneous sarcoidosis following Mycobacterium marinum infection of skin.

Sarcoidosis has long been associated with mycobacterial infection, especially with Mycobacterium tuberculosis, although a causal association has not been proven. Atypical mycobacteria have also been implicated in causing sarcoidosis, but there is as yet no conclusive evidence. We report the activation of cutaneous sarcoidosis following infection with M. marinum, raising further questions about the role of these bacteria in causing this chronic granulomatous disorder.

Humans↗
PubMed2000

Expanding tissue viability practice through telemedicine.

Telemedicine can be defined as the electronic transfer of medical information to remote sites in order to support patient care and medical education (Norton et al, 1997). The concept of telemedicine has been around for more than 20 years; however, with the advantages of affordable technology it is set to play a major role in the future of health care. The use of telemedicine within the field of dermatological practice is well documented in the literature but the use of this referral system by clinical nurse specialists in tissue viability appears to be in its infancy. This article seeks to dispel the myths around the use of technology to enhance clinical practice and uses the authors' personal experience to describe its effectiveness for referring patients with complex tissue viability needs.

Humans↗
PubMed2000

Adaptation of pregnant ewes to an exclusive onion diet.

A diet consisting entirely of cull onions fed to pregnant ewes produced Heinz body hemolytic anemia in all sheep after 21 d. After 28 d of daily consumption of 20 kg of onions/ewe, the anemia stabilized, and for the remaining 74 d the packed cell volume increased in the majority of sheep, although it did not return to normal. Compared to control ewes fed an alfalfa and grain diet, the onion-fed ewes had comparable body condition scores and fleece weights. There was no significant difference (alpha = 0.05) in pregnancy or lambing rate, number of lambs born/ewe exposed, or number of lambs born/ewe lambing. Greater numbers of sulfate-reducing bacteria (Desulfovibrio spp) and more ruminal hydrogen sulfide were present in onion-fed sheep compared to controls. Although an average 27% reduction in packed cell volume and Heinz body anemia developed in the onion-fed ewes, on the basis of this study it appears that pregnant ewes may be fed a pure onion diet with minimal detrimental effects. This adaptation to a pure onion diet is in part likely due to the apparent ability of the sheep's rumen to quickly develop a population of sulfate-reducing bacteria that decrease the toxicity of onion disulfides.

Adaptation, Physiological↗
PubMed1999

Students' expectations of postregistration degree programmes.

The needs of postregistration students pursuing degree-linked clinical courses have received little attention and there are few insights concerning their aspirations when they enrol on such courses. Thus the aim of this study was to explore postregistration students' perceptions of the specific needs of their patient/client group and to examine how they envisaged the course on which they had just enrolled might help them to meet these needs in addition to their own requirements for professional and personal development. Data were collected by group interview from 62 students enrolling on eight different postregistration courses, all employed in an acute hospital trust. The results were analysed inductively. They indicated that students had internalized the state of the healthcare market and were keenly aware of the need to fulfil the expectations of employers and the public, while fulfilling their own needs for education and pursuing their own professional and career trajectories. They appeared ambitious and yet appeared to demonstrate empathy for patients and their families and felt a tremendous desire to provide care of a high quality through the optimal development of technical expertise. Students' emphasis on the importance of keeping abreast of technological developments should not be lightly dismissed considering its prominent position within the acute areas where they were employed, especially as it did not replace their desire to promote the caring aspects of their work.

Attitude of Health Personnel↗
PubMed1999

Psychosocial recovery from adult kidney transplantation: a literature review.

Kidney transplantation is the preferred treatment for patients with end-stage chronic renal disease. There appears to be no recent and extensive review of the literature on psychosocial recovery from adult kidney transplantation. This comprehensive review considers literature on six aspects of patient recovery and rehabilitation: psychiatric sequelae, functional recovery, stress and coping, the psychological impact of failed kidney transplants, quality of life (QOL), and adherence with medications. We conclude that although studies have become both more ambitious and rigorous, there is a pressing need to move away from descriptive research toward carefully designed multidisciplinary psychological intervention studies with kidney transplant patients.

Activities of Daily Living↗
PubMed1999

Patients' experiences of having an underwater seal chest drain: a replication study.

The nursing management of patients who have a chest drain in situ has received little attention. The findings of a single small-scale study previously indicated that such patients' needs for information are not always fully met and pain control is inadequate. This small-scale study was replicated to produce broadly similar findings in a second hospital 2 years later. Despite some differences in the approach to management it was apparent that patients were still not well prepared pre-operatively and there was scope for improving pain control. All the patients reported considerable discomfort and pain of moderate to severe intensity. The type of pain described is typical of deep somatic/visceral pain.

Activities of Daily Living↗