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Biomedical subjects

D Oakley

Publications and source records attributed to D Oakley.

At least 19 recordsLinked to original sources
PubMed2004

Predicting late sudden death from ventricular arrhythmia in adults following surgical repair of tetralogy of Fallot.

Tetralogy of Fallot was the first complex congenital cardiac defect to undergo open repair. The life expectancy and quality of life of those surviving surgery is now good, although late survival is compromised by the occurrence of sudden death. The emergence of successful methods for both the prevention of arrhythmias (including valve replacements and electrophysiological ablation) and the treatment of arrhythmias when they occur (including implantable defibrillators), has meant the identification of those at risk is of even greater importance. This paper reviews the predictive methods currently available to the practising physician caring for these increasingly common patients.

Adult↗
PubMed2001

Using cognitive theory to improve nurse practitioners' anticipatory guidance with contraceptive pill users.

Community health nurse practitioners are often the major contraceptive counselors who may use anticipatory guidance to help clients' use behaviors. Because pregnancy rates during typical use are much higher than during "perfect" use, more effective anticipatory guidance could help improve use behaviors. Principles of cognitive theory were used to explore the implications of specific words and approaches associated with discussing young adults' contraceptive use. Qualitative results are reported here, and potential implications are made for nurse practitioners' anticipatory guidance related to contraceptive use.

Adult↗
PubMed1999

Combining qualitative with quantitative approaches to study contraceptive pill use.

According to large-scale studies, oral contraceptive users become pregnant at rates that exceed ideal use failure rates. It is thought that a major cause is missed pills, but current research on consistent contraceptive pill taking is characterized by inadequate measures and a failure to investigate women's thinking about their own patterns of use. The purpose of this study was to gain some understanding about women's interpretations of consistency in their own pill taking through combining qualitative with quantitative data. The study was conducted in China, where contraception is free and widely available. Five urban and five rural oral contraceptive users were followed for up to three pill-taking cycles during 1996 for a total of 759 person-days. Consistency of pill taking was measured with electronic data obtained from a new blister package made by Anderson Clinical Technologies (Elmhurst, IL). Data from these devices were reviewed and interpreted by the study participants during in-depth private interviews. The users' reasons for missing pills included disruptions in their daily routines, their husband's absence, spotting, and trouble implementing the family planning program's instructions to take one pill per day for 22 days and start the next cycle on the fifth day of menses. One user gave these reasons for two cycles but denied missing numerous pills in her third cycle. Data from a series of four questionnaires showed that most demographic, psychosocial, and service system characteristics were not related to missed pills. However, results suggested that the daily routines of rural living may make consistent use more likely and that instructions for taking the pill may be associated with prolonged pill-free intervals and skipping pills during episodes of spotting. Three of the 10 women were at increased risk of pregnancy during the study period because of their pill-taking pattern. We concluded that the combination of qualitative with quantitative data enhances understanding of contraceptive use. Women themselves offer plausible reasons for their use behaviors. Listening to women could be useful in improving programs.

Adolescent↗
PubMed1996

Pathways of influence on fifth and eighth graders' reports about having had sexual intercourse.

The purposes of this study were to explore the differences between fifth and eighth graders' self-reports of having initiated sexual intercourse and the factors related to their early sexual debuts. The urban sample consisted of African American and white fifth (n = 59) and eighth (n = 169) graders. Among fifth graders 46% and among eighth graders 55% reported they had initiated sexual intercourse. Sexual intercourse was more common than other risk behaviors such as cigarette smoking and drinking. The multivariate analyses indicated that the influences on the early initiation of sexual intercourse were complex. Specifically, gender, use of alcohol, costs (i.e., perceptions of negative consequences), and personal norms (i.e., beliefs about when to initiate sexual intercourse) had no direct influence on having initiated sexual intercourse, but indirectly affected the initiation of sexual intercourse through the frequency of other intimate behaviors. The findings are discussed in terms of gender-specific socialization into sex roles and the need to design risk reduction interventions that incorporate messages from multiple social sources.

Adolescent↗
PubMed1996

Comparisons of outcomes of maternity care by obstetricians and certified nurse-midwives.

OBJECTIVE: To determine whether pregnancy outcomes differ by provider group when alternative explanations are taken into account. METHODS: Pregnancy outcomes were compared for 710 women cared for by private obstetricians and 471 cared for by certified nurse-midwives. At intake, all women qualified for nurse-midwifery care. They were retained in their original group for analysis, even if they were later referred to physicians. Infant and maternal mortality, 30 clinical indicators, satisfaction with care, and monetary charges were studied. The study site's history and philosophy of honoring consumer choice of provider precluded random assignment, but multivariate analyses minimized the effects of multiple confounding factors. The statistical power was adequate for the study design. RESULTS: Significant differences (P < .05) between the obstetrician and nurse-midwife groups were found for seven clinically important outcomes: infant abrasions (7 versus 4%), infant remaining with mother for the entire hospital stay (15 versus 27%), third- or fourth-degree perineal laceration (23 versus 7%), number of complications (0.7 versus 0.4), satisfaction with care, average hospital charges ($5427 versus $4296), and average professional fee charges ($3425 versus $3237). When maternal risk, selection bias, and the medical intensiveness of care were controlled, the provider group did not continue to have an independent effect on infant abrasions, hemorrhage, and professional fee charges; when women's preferences were added, the difference in hospital charges disappeared. However, the provider group continued to have significant independent effects on the other four outcomes. Interaction effects were not significant. CONCLUSION: Although most outcomes were equally good, important differences between obstetrician and nurse-midwife care remained after multivariate analysis.

Adolescent↗
PubMed1995

Quality of condom use as reported by female clients of a family planning clinic.

OBJECTIVES: This study analyzed the prevalence and determinants of the quality of condom use after a woman's first visit to a family planning clinic. METHODS: This report presents data from 360 female family planning clients who reported using condoms as their primary method of contraception for at least 1 sexually active month during the study's follow-up period after their first clinic visit. RESULTS: Only 1% always engaged in all five use behaviors studied: using a condom for each sexual intercourse, putting the condom on before first entry, withdrawal after intercourse while there is still an erection, holding on to the condom's rim during withdrawal, and using foam. Multiple linear regression indicated that more effective condom use was reported by women who had not had an induced abortion, were not using condoms just because they were starting oral contraceptive pill regimens, had more knowledge about birth control in general, had received a nursing intervention, and had more communication with their partner. CONCLUSIONS: Increasing attention needs to be devoted to understanding determinants of the specific actions that differentiate between more and less effective contraceptive use.

Adolescent↗
PubMed1994

Rethinking patient counseling techniques for changing contraceptive use behavior.

Some women who use contraception become pregnant. Determinants of pregnancy in these women are fecundity, frequency of intercourse, contraceptive method, and contraceptive behaviors. Current counseling content emphasizes the choice of method, with "education" about a limited set of use behaviors. A listing of use behaviors for oral contraceptives (OCs) shows that "use" should be conceptualized as multidimensional with numerous levels and not a simple dichotomous concept of use versus nonuse. The multidimensional understanding of "use" suggests the need for multidimensional counseling to affect distal determinants of use behaviors: knowledge, motivation, ability, and intentions. A review of behavioral theories suggests that various techniques can be used, in addition to the current emphasis on history taking and patient education, to help women have effective use behaviors. These include assessment for need and individualized counseling. With use of techniques that are widely recognized in other intervention programs, the emphasis of contraceptive counseling would be on the future, on intentions and behaviors, and on mobilizing self-planning and action by the OC user.

Contraception↗
PubMed1994

Use of therapeutic ultrasound in percutaneous coronary angioplasty. Experimental in vitro studies and initial clinical experience.

BACKGROUND: Previous studies have shown the feasibility of peripheral arterial ultrasound angioplasty. METHODS AND RESULTS: In this report, we describe the use of percutaneous therapeutic ultrasound for coronary angioplasty. In vitro, 11 postmortem, atherosclerotically occluded coronary arteries were obtained to assess catheter-delivered ultrasound for arterial recanalization as well as for assessment of the size of particulate debris. Clinically, coronary ultrasound angioplasty was performed in 19 patients (mean age, 56 years) to assess safety and feasibility for the treatment of obstructive coronary atherosclerosis. Three patients with unstable angina and 16 with exercise-induced myocardial ischemia were treated with a prototype 4.6F coronary catheter ultrasound ablation device with a 1.7-mm diameter ball tip. The ultrasound coronary catheter delivered ultrasound energy at 19.5 kHz, with a power output of 16 to 20 W at the transducer. Energy is delivered in a pulsed mode with a 50% duty cycle of 30 milliseconds. Patients were treated for a mean of 493 seconds (range, 130 to 890) with intracoronary ultrasound ablation. All lesions were treated with adjunctive balloon angioplasty. All 11 postmortem coronary occlusions were recanalized, and 99% of the particulates generated were < 10 microns in diameter. We found that after ultrasound, mean (+/- SD) coronary arterial stenosis fell from 80 +/- 12% to 60 +/- 18% (P < .001) and to 26 +/- 11% (P < .001) after adjunctive balloon angioplasty. Mean pressures required to achieve full balloon inflation were 2.7 atm (range, 1 to 5.5) with a median of 3.0-mm balloon size (2.5 to 3.5). No ultrasound-related complications were identified. CONCLUSIONS: Intracoronary ultrasound plaque ablation appears to be safe. Our findings suggest that catheter-delivered high-intensity, low-frequency ultrasound may be useful for lesion debulking and enhancing arterial distensibility, allowing balloon dilation at relatively low pressures.

Angioplasty, Balloon, Coronary↗
PubMed1994

Effects of a low-dose fish oil concentrate on angina, exercise tolerance time, serum triglycerides, and platelet function.

Fish oils have shown beneficial effects on various parameters in patients with coronary artery disease (CAD). The purpose of this study was to investigate whether the same effects can be demonstrated with a low dose of fish oil concentrate (FOC). Thirty-nine patients were studied and divided into two groups. Twenty were given 10 g fish oil (group A) and 19 were given 10 g placebo Italian olive oil (group B). Weekly anginal attacks (AA), weekly glyceryl trinitrate consumption (GTN), exercise tolerance time (ETT), serum triglycerides (ST), platelet aggregation ratio (PAR), and beta-thromboglobulin were measured at eight and twelve weeks after start of treatment. 1. The number of anginal attacks recorded by both groups decreased by 41% in group A reaching statistical significance (P < 0.05). No change was observed in group B. 2. GTN consumption decreased in group A (P < 0.05) with no significant change in group B (P:ns). 3. ETT increased significantly in group A eight and twelve weeks after start of treatment (20.6% P < 0.01, 22.6% P < 0.01). A smaller but insignificant increase was observed in group B (P: ns). 4. ST decreased significantly in group A by 22% eight weeks after start of treatment (P < 0.01) and to a lesser degree (11%) twelve weeks after start of treatment (P: ns). In group B, ST slightly increased (P: ns). 5. No statistically significant change was observed in either group in regard to PAR and beta-thromboglobulin (P: ns). These observations suggest that dietary supplementation with a low dose of FOC may have beneficial effects on the clinical status of patients with CAD.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Collaboration as an organizational process.

Successful collaboration does not happen by chance. An understanding of organizations and systems, and planned preventive and corrective actions are needed. These two different experiences with health departments in two different states have helped elucidate the relevant principles and provided examples that may be useful to others in building collaborative research relationships.

Communication↗
PubMed1991

Community health nurses' knowledge of, attitudes toward, and involvement with adolescent contraceptive services.

A national sample of community health nurses were surveyed to assess their knowledge of, attitudes toward, and involvement with reproductive health services. Results indicated that slightly more than half of the nurses provided or administered contraceptive services to adolescents, although 73% worked in settings where contraceptive services were provided to adolescents. However, only 3.6% indicated that adolescents were their primary client population. The majority (64.3%) stated that they felt as prepared to work with adolescents as they did with adult clients. While 98% were aware that most adolescents are sexually active before seeking family planning services, a minority correctly answered questions about pregnancy and contraception among adolescents. Ninety-five percent agreed that contraceptives should be available to adolescents, and 90% agreed that parental consent should not be required for adolescents seeking contraceptive services. Yet only 21.5% were aware of the implications of the Adolescent Family Life Act.

Adolescent↗
PubMed1990

Public health nurses and family planning.

Unintended pregnancy is a health problem that is particularly important in the practice of public health nurses (PHNs). Data from 844 PHNs showed that they were likely to practice in settings that incorporate family planning services and were knowledgeable about specific family planning methods. They favored family planning services and an expanded supportive government role in both family planning and abortion. Since PHNs are an important resource for the community activism required to build the consensus needed to expand these services, a multiple-regression analysis was performed to determine predictors of activism. Political participation was the major predictor for activism on both family planning and abortion.

Community Participation↗