UK handwashing initiative.
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Cross Infection↗
Biomedical subjects
D Gould
Publications and source records attributed to D Gould.
Longitudinal aneurysm shrinkage following endovascular aortic aneurysm repair: a source of intermediate and late complications.
PURPOSE: To report the incidence of delayed complications following endovascular abdominal aortic aneurysm (AAA) repair and the relationship of these sequelae to morphological changes in the sac and endograft. METHODS: Twenty-six AAA patients treated with Vanguard endografts had completed > or = 1-year follow-up. Postoperative angiograms and spiral computed tomographic (CT) scans with 3-dimensional reconstruction were compared to the 1-year images to determine morphological changes in the aneurysm sac and the endograft. These changes were then related to complications occurring between 1 and 12 months postoperatively in the study group. RESULTS: Comparison of angiograms uncovered endograft buckling in 18 (69%) patients and acutely angled or kinked endografts in 10 (38%). Measurements from the CT scans found that undistorted endografts had a mean change in sac length of +6.6 mm. Mean sac length change in buckled endografts was -3.1 mm, while kinked endografts displayed a mean change of -6.2 mm (p < 0.002, Student's t-test). Five (19%) patients, all with distorted endografts, demonstrated late (1 to 12 months) complications (4 endoleaks and 1 graft limb thrombosis) owing to component separation, distal stent migration, and acute angulation. No movement in the proximal stent was observed. Elongation of the endograft (flow line measurement) was observed in one tube graft only. CONCLUSIONS: In this study, longitudinal shrinkage of the sac following endovascular aortic aneurysm repair led to buckling or kinking of the endograft within 1 year in 69% of patients. This appears to be an important source of delayed complications.
Aged↗
Endotension after endovascular aneurysm repair: definition, classification, and strategies for surveillance and intervention.
In the ongoing evolution of a categorization system for endoleak, the authors propose the term endotension to define persistent or recurrent pressurization of the aortic aneurysm sac after endovascular repair. Endotension is evidence that the aneurysm remains at risk of rupture and should, therefore, be considered an indication for secondary intervention. Management strategies and a grading system for endotension are offered.
Aneurysm, Ruptured↗
The Cornwall dermatology electronic referral and image-transfer project.
An evaluation of a store-and-forward electronic referral system was carried out in Cornwall to gauge its effectiveness in prioritizing dermatological patients needing secondary care. A dermatologist classified patients to be seen according to need based on information on the electronic referral form along with an image of the skin condition. Initial findings indicated that patients were more accurately triaged in at least 50% of cases and that 25% of patients did not require an outpatient dermatological appointment. Dermatologists rated image quality at 7.5 on a 10-point scale. This low-cost system has potential for more appropriate clinical management of dermatological patients in both primary and secondary care.
Computer Communication Networks↗
Quality of life after renal transplantation.
End stage renal disease (ESRD) inevitably reduces the life-span of its victims. The treatment of choice for many patients is transplantation but this does not effect a cure. Its aim is to improve renal function and thus to enhance the patient's ability to enjoy as full a life as possible. However, surprisingly little research has been concerned with quality of life after transplantation. A small-scale, exploratory study employing a qualitative design was undertaken to compare stress and quality of life between five patients with ESRD awaiting transplantation and five patients who had received a graft within the previous 6 months. The desire to undergo transplantation was fuelled by patients' perceived need to 'get off dialysis' and to 'lead a normal life'. All patients had received abundant technical information about renal transplantation and pre-operative preparation but information concerning the negative effects of transplantation, including the side-effects of medication appeared lacking. It was not possible to determine whether this information had not been supplied or had been offered but forgotten or denied. For pre-transplantation patients the main sources of stress were the need to undergo dialysis, awaiting the summons to hospital and the social isolation imposed by having a chronic condition such as constant fatigue. Post-transplantation patients were remarkably free of anxiety considering the impositions placed upon them by frequent clinic attendance to monitor their condition. Quality of life improved dramatically after transplantation despite the persistence of renal symptoms and patients felt privileged to have been offered this treatment option.
Activities of Daily Living↗
The cobweb syndrome: first trimester sonographic diagnosis of multiple amniotic bands confirmed by fetoscopy and pathological examination.
Amniotic band syndrome is a well described clinical entity presenting with deformities of the limbs, thorax, craniofacial skeleton, soft tissues and umbilical cord, but it still lacks a precise definition and a coherent hypothesis for its pathogenesis. We report on a case of first trimester diagnosis of amniotic band syndrome by sonography and fetoscopy. This revealed multiple abnormalities including facial cleft, brain and limb deformities; the appearance of the amniotic cavity was that of a cobweb containing the fetus. Post-mortem examination and histopathological studies confirmed the diagnosis of amniotic band syndrome. These results may enhance the knowledge of its natural course. In addition, based on histological and newly identified ultrastructural features, we present a hypothesis which could help to explain the aetiopathogenesis of the amniotic band syndrome.
Adult↗
Gene therapy for rheumatoid arthritis. Theoretical considerations.
Current understanding of the pathogenesis of rheumatoid arthritis has provided evidence that therapeutic benefit can be achieved by using antagonists targeted to the inflammatory cytokines involved, mainly tumour necrosis factor-alpha and interleukin-1. Gene delivery of antagonists, which can inhibit the production or action of these cytokines and other mediators, has been achieved in experimental animal models. This new method of delivery can produce therapeutic effects at lower concentrations and in a local environment, overcoming the adverse effects that often accompany protein therapy. However, several technological and biological restraints preclude the immediate adaptation of this method to human treatment. Based on the experimental evidence, possible target therapeutic genes, cell types and vector systems that could be used are discussed in this article.
Arthritis, Rheumatoid↗
Unilateral breast oedema as a manifestation of congestive heart failure.
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Breast Diseases↗
Patient self-administration of medication: a review of the literature.
The purpose of this review was to critically examine the literature published in the English language (1983-1995) related to the use of self-medication programmes by hospital patients and to determine whether such a scheme could be implemented and evaluated within the acute medical setting. Searches revealed a wealth of information relating to self-medication and it was evident that such schemes have been welcomed with enthusiasm by clinical nurses. However, only 12 empirical studies evaluating the advantages and disadvantages of self-medication programmes could be located. The remainder were all anecdotal or described the process of implementation in such broad terms that they could not be considered to fulfil the rigorous requirements demanded of research studies. Even the 12 empirical studies contained serious methodological flaws. Thus authors' claims that self-medication increased compliance with the drug regime could not be accepted with confidence. Nevertheless, the authors made a number of sensible recommendations which logically would be expected to increase compliance. These included simplification of the drug regime and careful patient assessment with the programme tailored to meet individual need. It was also possible to highlight areas where future research could be conducted (e.g. more detailed examination of the importance nurse-patient interaction to the success of self-medication, longer-term evaluation) and to identify means of improving research designs so that this important field of patient care may in future be examined with greater rigour.
Attitude of Health Personnel↗
Non-adherence with medications in organ transplant patients: a literature review.
The problems of non-adherence with treatment in health care in general, and with medication adherence in particular, is an area with a voluminous and burgeoning literature. However, there appears to be no review of the literature on non-adherence with medications in organ transplant patients. This comprehensive review therefore considers literature on adherence in adult kidney, heart and liver transplantation. The particular problem of adherence in paediatric transplant patients is also addressed. This transplant research literature is then evaluated within the broader context of social science research on medication adherence. From the review it is apparent that there is an urgent need for research which examines the patient's beliefs about their illness and medicines. Such research is a precursor for rigorous nursing intervention studies which aim to promote adherence by being tailored to the patient's perceptions.
Adult↗
Stress and quality of life in the renal transplant patient: a preliminary investigation.
End-stage renal disease is a chronic condition which reduces the life-span of its victims. At present there is no cure. Renal transplantation, currently the treatment of choice for many patients, is potentially associated with a number of drawbacks: constant risk of rejection, especially during the first six months, the need to comply with a complex regime of medication capable of producing pronounced side-effects and need for ongoing medical supervision. Despite these problems, little research has been undertake with patients following renal transplantation. The aim of the small-scale, exploratory study reported here was to explore patients' perceptions of stress and quality of life at different stages following a first, functioning renal graft: within six months, between one and five years and over five years later (n = 10 in each group). From the results it became apparent that patients had a number of concerns, of which fear of rejection was the most frequently mentioned, followed by stress generated through altered body image (a product of immunosuppressive therapy). Nevertheless, all reported a significant increase in quality of life after transplantation, although improvement was least marked in patients in the intermediate group (1-5 years after surgery) who also experienced most stress. A larger scale study is recommended to increase the validity of findings which clinicians could then use to design patient interventions to enhance quality of care and quality of life.
Attitude to Health↗
The use of a ward-based educational teaching package to enhance nurses' compliance with infection control procedures.
Obtaining study leave is becoming difficult for clinical nurses in the current economic climate, but the need to develop new clinical skills and to maintain existing good practice remains of prime importance to patient care and will become mandatory with the advent of post-registration education and practice (PREP) in the UK. The ward is widely acknowledged as the best venue for learning clinical skills by nurse educationalists and for many nurses is the preferred learning environment. The feasibility of using a ward-based teaching package to enhance nurses' compliance with key infection control precautions (hand decontamination, the use of gloves and the safe handling and disposal of sharp instruments) was tested in a quasi-experimental research study conducted on matched surgical wards in a teaching hospital, controlling for variables likely to influence performance (knowledge, availability of resources to perform infection control, previous opportunity to develop infection control expertise and nursing workload). Nurses on two wards received the intervention (experimental group). The remaining wards, which received no intervention, operated as controls. The ward-based sessions consisted of a carefully planned sequence of theory and practical demonstration delivered to qualified nurses in the clinical environment at convenient times selected by the ward managers. Performance of infection control precautions was audited before the intervention and 3 months afterwards. The sessions were well evaluated and the clinical environment was considered suitable for teaching by the nurses, but heavy and unpredictable workload prevented the teaching programme from being implemented as planned. The analysis of covariance failed to detect any changes in performance between nurses in the control and experimental groups. The implications of the study findings are discussed to help develop creative new ways of strengthening ward-based educational programmes.
Education, Nursing, Continuing↗
Interspecialty differences in the obstetric care of low-risk women.
OBJECTIVES: This study examined differences among obstetricians, family physicians, and certified nurse-midwives in the patterns of obstetric care provided to low-risk patients. METHODS: For a random sample of Washington State obstetrician-gynecologists, family physicians, and certified nurse-midwives, records of a random sample of their low-risk patients beginning care between September 1, 1988, and August 31, 1989, were abstracted. RESULTS: Certified nurse-midwives were less likely to use continuous electronic fetal monitoring and had lower rates of labor induction or augmentation than physicians. Certified nurse-midwives also were less likely than physicians to use epidural anesthesia. The cesarean section rate for patients of certified nurse-midwives was 8.8% vs 13.6% for obstetricians and 15.1% for family physicians. Certified nurse-midwives used 12.2% fewer resources. There was little difference between the practice patterns of obstetricians and family physicians. CONCLUSIONS: The low-risk patients of certified nurse-midwives in Washington State received fewer obstetrical interventions than similar patients cared for by obstetrician-gynecologists or family physicians. These differences are associated with lower cesarean section rates and less resource use.
Adult↗
Underwater seal chest drains: the patient's experience.
Chest drains are routinely inserted during thoracic surgery and to conservatively manage spontaneous pneumothorax. An extensive search of the literature revealed only a small number of highly prescriptive articles to advise the nurse on the specific care needs of this patient group. An exploratory study undertaken with 18 patients drew attention to the persistent discomfort and pain experienced by patients throughout the entire time that the chest drain remained in situ. Most of the patients also experienced short-lasting but intense pain when the chest drain was removed. Patients appeared ill-prepared for their experiences despite opportunities to obtain verbal and written information from staff.
Adult↗
Genetics of bladder cancer.
Bladder cancer manifests many different forms, ranging from superficial to aggressive muscle invasion, which suggests that various genetic alterations are responsible. Several attempts have been made to establish correlations between specific genetic alterations and various grades of the disease. Numerous types of chromosomal abnormalities have been observed, involving [1p, 1q, 2q, 3p, 4p, 5q, i(5p), +7, +8, 8p, 9p, 9q, 10q23-25, 11p, 11q, +11, 13q, 14q, 17p, 18q, 21q, and Y]. In addition, p53 mutations and loss of heterozygosity on various chromosomes have recently begun to shed light on the molecular pathways of transitional cell carcinomas of the bladder. We have begun to focus on specific genomic sites (especially 9q), although the heterogeneity of the disease and the variable presentation suggests divergent progression pathways. When the genetic basis of bladder cancer is fully understood, new diagnostic and therapeutic strategies will be developed, which in turn may promote better clinical management by pathologists and urologists.
Chromosome Aberrations↗
Nurses' infection-control practice: hand decontamination, the use of gloves and sharp instruments.
Infection is an acknowledged hospital problem. Micro-organisms are disseminated mainly via hands but there is evidence that hand decontamination, the most important means of prevention, is performed too seldom, and not always after activities likely to result in heavy contamination. Nurses themselves are exposed to risks of infection, chiefly through contact with blood and body fluids, yet it has also been reported that gloves are not always worn during contact with patients' secretions and that the handling and disposal of sharp instruments may be performed unsafely. The study reported in this paper documents nursing behaviour in relation to hand decontamination, the use of gloves and sharps, taking into consideration a number of variables which could influence practice: availability of the expertise afforded by an infection-control nurse, clinical setting, nursing workload, knowledge and the resources available to control infection. Hands were decontaminated after 28.78% of patient contacts. Hands were decontaminated after 49.85% of activities likely to result in heavy contamination. Performance was related to nursing workload and the availability of hand decontaminating agents, especially when the nurses became busy. Use of gloves when they were available also proved good, with little evidence of wasteful use. The handling and disposal of sharps were commendable for most subjects but a few grossly unsafe incidents were nevertheless witnessed, apparently not associated with any of the variables examined.
Analysis of Variance↗
Endotracheal suctioning in adults with severe head injury: literature review.
Endotracheal suctioning is a routine but potentially dangerous nursing procedure. The research literature documenting approaches to minimising the complications of endotracheal suctioning in adults with severe head injuries is reviewed. Hyperoxygenation, hyperventilation, hyperinflation, normal saline instillation and the effects of endotracheal suctioning on intracranial pressure and cerebral perfusion pressure are examined. Recommendations for an evidence-based endotracheal suctioning protocol are made.
Adult↗
Using vignettes to collect data for nursing research studies: how valid are the findings?
Vignettes are simulations of real events which can be used in research studies to elicit subject's knowledge, attitudes or opinions according to how they state they would behave in the hypothetical situation depicted. Advantages associated with the use of vignettes as research tools include: the ability to collect information simultaneously from large numbers of subjects, to manipulate a number of variables at once in a manner that would not be possible in observation studies, absence of observer effect and avoidance of the ethical dilemmas commonly encountered during observation. Difficulties include problems establishing reliability and validity, especially external validity. This paper considers the advantages and disadvantages associated with the use of vignettes as data collection tools, concluding with a check-list to help critique vignettes studies.
Bias↗