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D Nicholas

Publications and source records attributed to D Nicholas.

At least 19 recordsLinked to original sources
PubMed2001

Health information: an evaluation of the use of touch screen kiosks in two hospitals.

An exit questionnaire survey of 150 hospital users of a touch screen health information kiosk was undertaken. It was compiled by Royal Cornwall Hospitals NHS to evaluate kiosk use and was reanalysed by researchers at City University to determine whether the information obtained went anyway to meeting patients' information needs. The study established two effective outcome variables on kiosk use: whether the information found answered the users' questions and if users intended, after using the kiosk, to find more information elsewhere. Two-thirds of respondents said that the information found had answered their question, whilst 16% said that after using the kiosk they still had further questions and intended to talk to a health professional to obtain this information. The variables found to have an impact on the information outcome included: gender, navigational ease, object of search, and ease of reading and understanding the information.

Adolescent↗
PubMed1999

Development of a quality-of-life index for pediatric inflammatory bowel disease: dealing with differences related to age and IBD type.

BACKGROUND: A child- and adolescent-generated IBD quality-of-life index was designed to be descriptive (to be used to assess the overall impact of IBD on individual patients), and evaluative (to be used as an outcome measure in clinical trials). METHODS: Item-generation and item-reduction interviews with 82 patients with IBD aged 8 to 17 years (61 with Crohn's disease, 21 with ulcerative colitis; 36 girls, 45 boys) generated a list of ways in which their lives were affected by IBD. These issues were incorporated into an item-reduction questionnaire, which was administered to 117 patients (87 Crohn's disease, 30 ulcerative colitis). Patients indicated on a visual analog scale how important an item was to them and how often it bothered them. Mean and median importance-plus-frequency scores for each issue were calculated for the entire group and among patients in subgroups according to age and IBD type. RESULTS: Ulcerative colitis and Crohn's disease affect the lives of children and adolescents differently. Bowel symptoms are more troubling and disabling to patients with ulcerative colitis, whereas systemic symptoms and body image concerns are greater for patients with Crohn's disease. The impact of Crohn's disease on ability to function in school and leisure activities is greater. Worries about future health problems and about the effects of IBD on the family are shared. Crohn's disease and ulcerative colitis trigger emotional responses of unfairness and frustration, but anger and embarrassment are more prevalent in ulcerative colitis. Disparities between age groups are fewer and less marked than those between types of IBD. CONCLUSION: In selection of items to be retained in a pediatric IBD quality-of-life measure, the variation in concerns with disease type must be considered. A single index to assess IBD-related quality of life must include items of major importance to one subgroup of patients, even if not important to all. Alternately, a core of common concerns could be supplemented by disease-specific modules, thereby increasing the content validity of the tool for all patients.

Adolescent↗
PubMed1998

Perceived outcome of social work intervention: beyond consumer satisfaction.

This study identified and measured the predictive value of specific indicators of consumers' overall perception of a hospital-based social work service. A review of the health and social work literature revealed a number of distinct "components" which predict overall satisfaction with the service a patient receives. A questionnaire evaluating client perceptions of each component was developed and administered to 83 randomly selected respondents. The study also gathered information about perceptions of patients/families regarding the reason for social work involvement and the corresponding outcome measured on a goal attainment scale. Findings were positive concerning the value of social work. The results suggest that the "components" of satisfaction that were tested were relevant as they were positively and significantly associated with patients' overall rating of the social work service. Implications for practice are discussed.

Adolescent↗
PubMed1996

External radiation protection audit in National Health Service hospitals. Radiation protecgtion advisors (RPA) of the Nottingham City Hospital NHS Trust and the Oxford Radcliffe Hospital NHS Trust.

Radiation protection advisers are accustomed to carrying out internal audit in organizations for which they provide services but, traditionally, external audit has not been a part of the radiation protection adviser function. To provide an external audit function, two teams of radiation protection advisers undertook external radiation protection audits of their respective organizations, including the radiation protection adviser function itself. These audits were more representative of audits or inspections carried out by government agencies, for example the Health and Safety Executive and the former Inspectorate of Pollution, now the Environment Agency. Subsequently, reports, including recommendations for remedial action, were prepared for each management by the external auditors. The process of setting up and carrying out the external audits is described. Guidelines are suggested for those seeking to carry out an external audit.

England↗
PubMed1996

High-altitude pulmonary edema at a ski resort.

Medical records of 150 patients with high-altitude pulmonary edema seen over a 39-month period in a Colorado Rocky Mountain ski area at 2,928 m (9,600 ft) (mean age 34.4 years; 84% male) were reviewed. The mean time to the onset of symptoms was 3 +/- 1.3 days after arrival. Common symptoms were dyspnea, cough, headache, chest congestion, nausea, fever, and weakness. Orthopnea, hemoptysis, and vomiting were rare, occurring in 7%, 6%, and 16%, respectively. Symptoms of cerebral edema occurred in 14%. A temperature exceeding 100 degrees F occurred in 20%, and 17% had a systolic blood pressure of 150 mm of mercury or higher. Blood pressures were higher in patients older than 50 years (142 mm of mercury). Rales were present in 85%, and a pulmonary infiltrate was present in 88%; both were most commonly bilateral or on the right side. The amount of infiltrate was mild. Men appeared to be more susceptible than women to high-altitude pulmonary edema. Pulse oximetry in 45 patients showed a mean oxygen saturation of 74% (38% to 93%). Treatment methods depended on severity and included a return to quarters for portable nasal oxygen, an overnight stay in the clinic for continuing oxygen, or a descent to Denver for recovery or admission to a hospital. All patients received oxygen for 2 to 4 hours in the clinic. There were no deaths or complications.

Adolescent↗
PubMed1995

Attitudes of dialysis patients and caregivers regarding advance directives.

OBJECTIVE: The objective of this study was to describe and compare the attitudes of dialysis patients, their relatives/friends, primary nephrologists, and nurses regarding advance directives. DESIGN: A descriptive comparative design was used. SAMPLE/SETTING: A total of 50 dialysis patients from a large teaching hospital in western Canada participated in the study. For every patient who responded, a relative/friend, physician, and nurse completed the questionnaire. METHODS: The questionnaires were designed for the purposes of the study. These questionnaires were mailed to dialysis patients, who were asked to identify a relative/friend to complete a similar questionnaire. Nurses and physicians also completed questionnaires. RESULTS: Overall, 84% of patients indicated that they believed that it was important to leave a living will, but only 18% of these patients had actually left an advance directive. However, 52% of patients and relatives/friends believed that major treatment decisions should be left to the physician, a perception that was not shared by physicians and nurses. CONCLUSIONS: It appears that patients, family/friends, nurses, and physicians in this study had differing perceptions regarding advance directives. It is important that health care professionals realize that these differences may exist and that further research should address strategies to increase our understanding of patient decisions in this area.

Advance Directives↗
PubMed1993

Costing medical libraries: the feasibility of functional cost analysis.

As a result of organizational changes in the National Health Service (NHS) there is a need for a coherent costing model for NHS libraries, particularly for the smaller libraries based in postgraduate medical centres. One possible model is functional cost analysis, whereby all costs are assigned to library functions representing services to users, such as loans from stock, interlibrary loans, enquiry services, etc. Using data from a 1991 survey of postgraduate centre-based libraries in the North West Thames (NWT) Region of the NHS, the feasibility and appropriateness of functional cost analysis is examined.

Budgets↗
PubMed1991

Clinical application of an electronic imaging device for assisting patient set-up in radiotherapy.

As radiotherapy treatment set-ups are becoming more complicated and a greater emphasis is placed on accuracy, there is an increasing need to verify and record the actual treatments being given. A direct electronic imaging device is currently marketed by Varian (the DYNARAY ID), which uses the latest technology in detection and image processing to obtain digital images of the patient's anatomy using the actual treatment beam. At Norwich we have been using a prototype machine in a busy district radiotherapy centre and have examined over 50 patients. We have found the images easy to obtain and the technique superior to the standard practice of using verification radiographs. The role of this device lies in aiding quality assurance of treatments whilst generating a permanent record of the actual treatment given.

Evaluation Studies as Topic↗
PubMed1987

Comparison of computed tomography and conventional radiology in the assessment of treatment response of lytic bony metastases in patients with carcinoma of the breast.

Full skeletal survey, localised radiographs and computed tomography (CT) examinations were compared with clinical assessment in the evaluation of treatment response of bony metastases in 20 patients with carcinoma of the breast. Conventional radiology, skeletal survey and localised views compared poorly with clinical assessment agreeing in only 35% and 50% respectively. CT concurred with the clinical assessment in 65% of patients, particularly with respect to healing (86%). CT predicted the effect of treatment in six additional patients and this was confirmed on follow-up assessment. It is suggested that the use of skeletal surveys in monitoring treatment response is limited and that for critical evaluation of treatment CT should be the method of choice.

Adult↗
PubMed1987

Prognosis following chemotherapy for metastatic malignant teratoma.

A multiple regression analysis was performed of factors affecting the prognosis of 93 patients with metastatic malignant teratoma treated at the Royal Marsden Hospital between 1979 and 1981. In a subgroup of 53 patients, where exact tumour bulk could be calculated from sequential CT scan slices, a correlation was seen between tumour marker level and volume of metastatic disease. On analysis of the risk of relapse after initial chemotherapy, the independent adverse influence was detected of serum AFP greater than 500 micrograms/l and of bulky disease defined by clinical staging. An adverse influence of high serum HCG levels was not seen, probably due to the small number of patients in this series with this presenting feature.

Adult↗
PubMed1987

Benign thymic enlargement in adults after chemotherapy: CT demonstration.

Serial computed tomographic (CT) scans of 200 patients with malignant testicular teratomas were reviewed. Of the 200 patients, 120 were treated with chemotherapy for metastatic disease; 80 patients with no evidence of metastases (stage I disease) received no treatment and served as a control group. CT was performed at regular intervals for ongoing follow-up in both groups. Thymic enlargement occurred 3-14 months after initiation of treatment in 14 of the 120 patients (11.6%) who received chemotherapy but in only one patient in the control group. Histologic examination in one patient who received chemotherapy revealed that the thymic enlargement represented true hyperplasia. Thirteen of the 14 patients (93%) with thymic enlargement after chemotherapy were well and disease free on mean follow-up of 45 months, compared with 78% of the group that did not show thymic enlargement after chemotherapy (P less than .02). Rebound thymic hyperplasia in adults after chemotherapy for metastatic testicular teratoma may be a good prognostic feature and should be considered when an anterior mediastinal mass develops after chemotherapy for metastatic malignancy.

Adult↗
PubMed1987

Quantitative assessment of lung damage due to bleomycin using computed tomography.

Visual assessment and density measurements of the lung using computed tomography (CT) were made in 18 patients undergoing treatment with bleomycin for malignant teratoma of the testis. The results of both visual assessment and density measurements were compared with changes in gas transfer per unit lung volume (KCO). Visual assessment of severity of damage to the lungs caused by bleomycin is unrelated to changes in KCO but is characteristic of bleomycin damage and allows a confident diagnosis to be made. Quantitative density measurement by CT, however, is inversely related to changes in KCO and may therefore be used to monitor the physiological effect on the patient. Examination of the lung by CT in these patients can not only characterise and define the extent of lung damage due to bleomycin but can be used to give a quantitative measurement on which to monitor treatment.

Adult↗
PubMed1986

Tissue characterization from ultrasound B-scan data.

An approach to ultrasonic tissue characterization, using textural features of the B-scan image, is described. Portions of a B-scan image, 64 X 64 pixels spatially by 8 bits deep, are acquired from regions of interest and subjected to computer analysis. A systematic approach to defining a set of 93 textural features of a B-scan is described and methods and criteria for selecting optimum combinations of these are discussed. As a test of its power, the approach has been applied to the discrimination between the B-scan textures corresponding to livers and spleens of normal humans and various measures of "success" have been quantified both on a "training set only" and on a "training set plus test set" basis. The overall test probability of success of 82% on a single image and 94% on a subject yielding multiple images indicates the potential of the techniques for conditions where a subtle but uniform change in parenchymal texture may be present.

Computers↗
PubMed1986

Lung damage after hemithoracic irradiation: dependence on mouse strain.

A comparative study was performed on CBA, C57Bl mice and their F1 hybrid cross (CBBF1) after right hemithorax irradiation using doses ranging from 15 to 35 Gy. A dose-dependent increase in breathing rate was observed, corresponding to the expression of radiation pneumonitis in the irradiated lung. The use of hemithoracic irradiation enabled this to be observed without any lethality. Results obtained from X-ray computerized tomography (CT), lung weight and histology complemented the breathing rate studies. CBA mice showed a peak response at 16 weeks followed by a decline in breathing rate coincident with a compensatory hypertrophy of the shielded left lung. The manifestation of radiation pneumonitis in C57Bl mice was considerably delayed, supporting previous findings on whole-thorax irradiated animals. The latent period in CBBF1 hybrid mice was intermediate between the parent strains.

Animals↗
PubMed1985

The assessment of early and late radiation injury to the mouse lung using X-ray computerised tomography.

X-ray computerised tomography (CT) was performed on the lungs of CBA and C57Bl mice at varying time intervals after 13 and 16 Gy irradiation to the whole thorax. With careful consideration of artefacts associated with lung cross-sectional area and breathing rate, the mean density of the lung was evaluated in Hounsfield units (CT number). In CBA mice, this parameter showed a biphasic increase in lung density with time from irradiation, corresponding to an early phase of radiation pneumonitis and a late phase dominated by pleural effusions. Reduced lung volumes were also seen during the late response and lung compression due to accumulations of pleural fluid is considered a major factor in these observations. C57Bl mice did not develop radiation pneumonitis but appeared to be equally responsive to later radiation-induced increases in lung density. The results obtained from CT-derived densitometry compared well with measurements gained from functional and survival endpoints. X-ray CT provides a sensitive and informative technique for assessing the extent of radiation injury to the mouse lung and is potentially useful for quantifying the counterpart in patients.

Animals↗