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Biomedical subjects

D Gould

Publications and source records attributed to D Gould.

At least 73 records · Page 4Linked to original sources
PubMed1996

Endotracheal suctioning: an example of the problems of relevance and rigour in clinical research.

Endotracheal suctioning is a routine but potentially dangerous procedure. The literature documenting approaches to minimizing the cardiopulmonary complications of endotracheal suctioning is reviewed. Hyperoxygenation, hyperventilation, hyperinflation and the use of adaptors are all evaluated. The effects of endotracheal suctioning on haemodynamics and oxygen transport are also examined. The traditional dualist approach to the respiratory and cardiovascular systems is contrasted with the recent emphasis on oxygen transport by the cardiopulmonary system. The trade-off between the rigour of laboratory studies (which can be well controlled but are difficult to generalize) and the relevance of clinical research (which is more easily generalized but which often lacks internal validity) is discussed. Although research studies have become both more methodologically and conceptually sophisticated, definitive recommendations for a safe and effective suctioning procedure still remain elusive.

Clinical Nursing Research↗
PubMed1996

Neutropenia and agranulocytosis in patients receiving clozapine in the UK and Ireland.

BACKGROUND: Clozapine can cause reversible agranulocytosis and neutropenia. This study documents the occurrence of blood dyscrasias and identifies predisposing risk factors. METHOD: An analysis was made of the haematological, demographic, and dosage data from a central database on 6316 patients receiving clozapine over four and a half years in the UK and Ireland. RESULTS: During the study period, 2.9% of the patients developed neutropenia and 0.8% developed agranulocytosis. The peak incidence of both disorders was in the first 6-18 weeks of treatment. Fatal agranulocytosis occurred in 0.03% of patients. After the first year of treatment, the incidence of agranulocytosis significantly decreased to the order noted with some phenothiazines. CONCLUSIONS: The use of a patient monitoring service kept the haematological risks associated with using clozapine within acceptable limits, particularly in view of the benefits of this medication in treatment-resistant schizophrenia.

Adult↗
PubMed1995

Staphylococcus aureus: a review of the literature.

Staphylococcus aureus has a long association with nosocomial infection. Problems date from the 1950s, although methicillin-resistant Staphylococcus aureus (MRSA) did not emerge until the following decade. Initially the pathogenicity of antibiotic-resistant strains was underestimated, and is still sometimes questioned, but today most authorities consider MRSA a serious threat, especially given current preoccupation with cost-effectiveness within the health service: nosocomial infection is associated with increased expenditure and may be regarded as a hallmark of indifferent nursing and medical care. This review documents the emergence of MRSA and recognition of the ensuing problems throughout the 1980s and early 1990s, with suggestions for nursing activities which could contribute towards improved control. Lessons learnt during outbreaks are seen to be of value, but there is also a need for staff at ward level to review routine practice continually so that awareness of activities likely to result in cross-infection is maintained. The use of protective clothing emerges as less important than handwashing, which may be periodically audited to maintain standards.

Cross Infection↗
PubMed1994

Nurses' hand decontamination practice: results of a local study.

Cross-infection in hospital occurs mainly via hands. Hand washing is the most effective means of prevention, yet it has been reported that hands are washed too seldom, often inappropriately and that technique is poor. However, these claims are often made without explaining precisely how data were collected. This study employed more rigorous criteria than earlier research to judge the appropriateness and technique of nurses' hand contamination. During the 2 h that they were observed nurses decontaminated hands after 28.7% patient contacts. The data were then reanalysed so that only those activities likely to result in heavy contamination were examined. This revealed that such 'essential' decontaminations were performed on 49.8% occasions. Differences were found between hospitals related to the availability of hand decontaminating agents, particularly when nursing workload became high. A scoring system to assess technique was developed for the study. Mean score was 8.6 out of 12. Technique was superior for nurses employed in intensive care units regardless of the hospital in which data were collected (P < 0.0001). Nurses' knowledge of infection control was poor, but those with more knowledge decontaminated hands more appropriately (P < 0.004), although they did not have a better technique. It is recommended that future research move beyond mere description, with its inevitable conclusion that clinical staff should improve performance, turning toward the identification of local barriers to effective practice. This could be followed by improvement in resources and educational intervention should these emerge as problematic.

Cross Infection↗
PubMed1994

Infection control as a topic for ward-based nursing education.

The link between nursing theory and practice remains a topic of ongoing debate. Related to this issue is the best place to effectively combine the two. The solution may be ward-based teaching programmes as part of formal continuing staff development, involving collaboration between college-based lecturers and acknowledged clinical experts. Using infection control as an example of a topic in need of regular and continual updating for qualified practitioners, it is argued that such programmes would be desirable because they would afford sufficient flexibility to fulfil individual learning needs and could be assessed to indicate whether nursing practice had been enhanced. Participants could be accredited for successful completion of ward-based programmes.

Accreditation↗
PubMed1994

Nurses' views of infection control: an interview study.

An interview study was conducted among 173 nurses in two hospitals to explore their views concerning infection risks to themselves and patients and to identify any problems they perceived in safely performing infection control precautions during routine activities. Subjects were interested in the topic of infection control and keen to perform optimally, but perceived difficulties related to lack of expert guidance whether or not they had access to an infection control nurse. In one hospital subjects identified shortages of vital equipment (gloves, appropriate handwashing agents), and this was corroborated on a checklist used independently to document the availability of resources. When the opinions of nurses working in intensive care, surgical and medical units were compared, few differences emerged other than those explained by variation in supplies of equipment, except that intensive care unit nurses were more likely to rate their patients and themselves as particularly at risk of infection, Nurses who had been qualified longer, with more than 3 years experience in their specialty, were more conscious of infection risks.

Cross Infection↗
PubMed1994

Nurses' attitudes towards termination of pregnancy.

This questionnaire study (n = 84) investigated several aspects of the attitudes of nurses of various grades and clinical settings towards termination of pregnancy (TOP). The majority of nurses had attitudes which lay within the undecided to positive range of the continuum, similar to findings from previous North American and British research. Very few were found to have extremely positive or negative attitudes. Several factors were significantly associated with negative attitudes towards TOP: frequency of involvement in TOP, length of time spent working on a gynaecology ward, religious affiliation, and ethnicity. Some discrepancy in nurses' attitudes was found with respect to both the length of a woman's gestation and the circumstances for which the procedure was being performed. In view of these findings, the implications for nursing practice are discussed.

Abortion, Induced↗
PubMed1994

Gram-negative bacteria. The challenge of preventing cross-infection in hospital wards: a review of the literature.

Gram-negative bacteria are responsible for a high proportion of nosocomial infections, particularly among the critically ill and those in hospital for long periods. Colonization (asymptomatic carriage on the skin) occurs before the emergence of overt clinical infection (appearance of the signs and symptoms of disease) and is therefore worth reducing. Spread is principally via the hands of staff, so handwashing is the chief method of prevention. Gram-negative bacteria survive best in a moist environment and are more readily transferred via damp than dry surfaces; hands and equipment should therefore be kept as dry as possible. Good skin can also help prevent cross-infection as Gram-negative bacteria colonize damaged skin more readily than if it is in good condition.

Cross Infection↗
PubMed1994

Psychological skills for enhancing performance: arousal regulation strategies.

This review summarizes and integrates current empirical and theoretical research on arousal regulation strategies for enhancing athletic performance. The need to view arousal as a multifaceted construct made up of both cognitive and physiological components was emphasized, as well as the importance of understanding arousal-performance relationship theories that go beyond a simple inverted-U notion. Categories of arousal regulation strategies were discussed and included: arousal energizing techniques, biofeedback techniques, relaxation response strategies, cognitive behavioral interventions, and mental preparation routines. It was concluded that these techniques can be effective in influencing arousal and facilitating performance. However, additional research (especially evaluation research) using more rigorous methods, determining how and why interventions work, using case study methodologies, identifying personality and situational factors influencing arousal regulation effectiveness, and identifying the most effective means of teaching arousal regulation is needed.

Arousal↗
PubMed1993

Coping strategies used by national champion figure skaters.

This investigation had two purposes: (a) to identify and describe the coping strategies used by national champion figure skaters and (b) to examine the relationship between coping strategies and particular stress sources. Participants were 17 of 20 (85%) Senior U.S. National Champion figure skaters who won titles between 1985 and 1990. All skaters were interviewed, and the interview transcripts were content analyzed. General coping dimensions reported by at least 40% of the skaters included (a) rational thinking and self-talk, (b) positive focus and orientation, (c) social support (e.g., receiving support from coach, talking with friends and family), (d) time management and prioritization, (e) precompetitive mental preparation and anxiety management (e.g., relaxation, visualization), (f) training hard and smart, (g) isolation and deflection (e.g., not letting things get to me, avoiding/screening media), and (h) ignoring the stressor(s). It was also found that the skaters implemented different coping strategies depending on the specific stressors encountered.

Adaptation, Psychological↗
PubMed1993

Coping strategies used by U.S. Olympic wrestlers.

Extensive in-depth interviews were conducted with all 20 members of the 1988 U.S. Olympic Wrestling Team regarding their efforts to cope with stress experienced during the Seoul Olympics. Qualitative analyses revealed that the wrestlers employed a variety of coping strategies including: (a) thought control strategies (blocking distractions, perspective taking, positive thinking, coping thoughts, and prayer), (b) task focus strategies (narrow, more immediate focus, concentrating on goals), (c) behavioral based strategies (changing or controlling the environment, following a set routine), and (d) emotional control strategies (arousal control, visualization). In accordance with the observations of Compas (1987) and Folkman and Lazarus (1985), the coping efforts of the Olympic wrestlers were not limited to particular strategies nor to single approaches to dealing with a particular stressor but, rather, reflected a dynamic complex process involving a number of strategies, often in combination. The results also suggested that the degree to which coping strategies are well learned or automatized is related to their perceived effectiveness.

Adaptation, Psychological↗
PubMed1992

Case report: heparin-induced thrombocytopenia--a complication presenting to the vascular radiologist.

Heparin-induced thrombocytopenia is an infrequent complication of heparin which causes thrombocytopenia and thrombosis. The vascular radiologist can expect to come across several cases in his/her career. A high index of suspicion is required for early diagnosis. This may befall the radiologist who is asked to provide thrombolytic treatment in a heparinized patient. We present such a case and discuss the clinical presentation, pathogenesis and management of heparin-induced thrombocytopenia.

Amputation, Surgical↗
PubMed1991

Nurses' hands as vectors of hospital-acquired infection: a review.

Hospital-acquired infections (HAI) are notorious for the manner in which they complicate the course of the original illness, increase costs of hospital stay and delay recovery. This review will briefly outline the problems presented by HAI in developed countries and present evidence that Staphylococcus aureus and gram negative bacilli, the main causative agents, reach susceptible patients via the contact rather than airborne route, predominantly on the hands of hospital staff. Good hand hygiene could help reduce the economic burden and patient distress caused by HAI, but there is evidence that it is infrequently and poorly performed by nurses, the health care staff most frequently in continuous contact with patients. Possible reasons are explored in an attempt to identify strategies to improve hand hygiene.

Cross Infection↗
PubMed1990

Empathy: a review of the literature with suggestions for an alternative research strategy.

Although empathy is regarded as a necessary component of good quality nursing care, defining and measuring empathy have both been fraught with problems. A historical overview helps to explain these difficulties, as nurses have tended to accept the views of psychotherapists uncritically, and have used scales developed for clients in counselling with people who are physically ill. Methodological difficulties combined with the results of studies demonstrating low levels of empathic ability in nurses have culminated in disenchantment with this topic. A framework is used to show why nurses cannot always demonstrate empathic awareness of every patient's need and an alternative approach for exploring the nature of empathy is suggested.

Empathy↗
PubMed1990

Weight loss, dietary carbohydrate modifications, and high intensity, physical performance.

Well trained subjects (N = 12) were studied before and after losing approximately 6% of body weight to determine whether physical performance could be maintained while consuming a hypocaloric, high percentage carbohydrate diet. During a 4-d period of weight loss, subjects were randomly assigned to a high carbohydrate (HC) or low carbohydrate (LC) diet. A crossover design was used; subjects were measured before (PRE) and after (POST) weight loss on both diets for a 6-min bout of high intensity arm cranking, weight, skinfold thickness, and profile of mood states (POMS). Hemoglobin, hematocrit, and glycerol concentrations were analyzed for resting blood samples, while lactate, pH, and base excess were analyzed for blood samples drawn at rest and 1, 3, and 5 min after arm cranking. A three-way ANOVA of sprint work revealed a weight loss effect, a diet by weight loss interaction, and an order by diet by weight loss interaction (P less than 0.05). Total sprint work (mean +/- SE) PRE and POST HC was 37.7 +/- 2.1 kJ and 37.4 +/- 2.2 kJ, respectively. Sprint work was higher for PRE LC vs POST LC, with mean values of 37.4 +/- 2.1 kJ and 34.4 +/- 2.2 kJ, respectively. Post-arm cranking lactate was significantly higher PRE compared to POST for both HC and LC. Post-exercise blood pH was lower (P less than 0.05) at PRE vs POST, with no diet effect. Regardless of the diet, POMS variables tension, depression, anger, fatigue, and confusion were significantly elevated from PRE to POST; vigor was significantly lower.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗