Search PubMed⌕ Search

Biomedical subjects

D Oakley

Publications and source records attributed to D Oakley.

At least 55 records · Page 3Linked to original sources
PubMed1980

The effect of prenylamine on the QT interval of the resting electrocardiogram in patients with angina pectoris.

Resting ECGs were recorded in 29 patients with angina pectoris before, during and after treatment with prenylamine 180 mg daily. The QT interval became significantly prolonged after one week of treatment. The prolongation persisted as long as therapy was continued, which was up to 6 months. After withdrawal of treatment the QT interval returned to normal within 2 weeks. In this study no serious problems were encountered by those patients in whom the QT interval was prolonged.

Adult↗
PubMed1980

Teaching and research on women's health issues in Schools of Public Health.

Women have been among the students and the faculty in Schools of Public Health since the early days of academic programs in public health. This report provides data on the recent past and current proportions of students and faculty who are women, and on the current quantity and type of teaching and research on women's health issues in the 22 North American Schools of Public Health. Teaching on these subjects is more widespread than research, but one or both are found in all but three of the schools.

Curriculum↗
PubMed1979

Relation between the precordial projection of S-T segment changes after exercise and coronary angiographic findings.

The recent introduction of electrocardiographic mapping permits measurement of the precordial area and severity of exercise-induced S-T segment changes. This study was designed to compare this technique with a modified 12 lead electrocardiogram in defining the degree and site of coronary artery disease. One hundred patients, who later had diagnostic coronary arteriography, underwent an exercise test using both 16 point precordial mapping and a modified 12 lead electrocardiogram. The sensitivity of electrocardiographic mapping (96 percent) for the diagnosis of coronary artery disease was significantly greater than that of the modified 12 lead electrocardiogram (80 percent). However, the specificity of the two lead systems was similar. Typical precordial projections of S-T segment change were found when the left main stem or proximal left anterior descending coronary artery were narrowed or when there was isolated disease of the left anterior descending or right coronary artery. Widespread precordial changes were found in patients with three vessel disease. Although there was no significant difference in the sensitivity (66 percent) and specificity (100 percent) of electrocardiographic mapping and of the 12 lead system in identifying three vessel disease, there was a significant difference in sensitivity (electrocardiographic mapping 74 percent, 12 lead system 42 percent) in identifying isolated single vessel disease. In addition, information regarding the presence of left main stem or proximal left anterior descending coronary arterial narrowing was obtained only with electrocardiographic mapping. The superiority of electrocardiographic mapping over the modified 12 lead electrocardiogram has been shown, and clinical application of this technique should be useful in the management of patients presenting with chest pain.

Adult↗
PubMed1978

Myocardial ischaemia in patients with frequent angina pectoris.

One hundred patients with angina pectoris underwent 16-point electrocardiographic (ECG) mapping of the left hemithorax during a standardised exercise test. Forty-five patients had maximum ST-segment depression at position V5, while 35 had no ECG signs of ischaemia at this position. In 20 V5 was on the edge of the precordial area, which showed less severe ST-depression than the central positions. An Oxford ECG recorder and highspeed analyser were modified and used in 50 of the patients with daily angina for recording ST-segment changes over 24 hours. Serial 24-hour ambulatory recordings from the edge of the precordial area of ischaemia identified during exercise detected a mean of only 14 +/- SD 3% of the episodes of ST-segment changes recorded from the centre of the same area. Only 16 +/- 2% of the episodes detected by ECG were accompanied by chest pain. More episodes occurred between 4 am and 6 am than at any other time during the night. This study shows the importance of recording ECG evidence of ischaemia from the precordial position showing maximum changes during exercise. ECG evidence of ischaemia occurs more frequently than anginal pain. These objective measurements add important information to the frequency of chest pain reported by patients with ischaemic heart disease.

Adult↗
PubMedDate not supplied

Theory building in nurse-midwifery. The care process.

Identifying what it is about the way nurse-midwives care for women that might contribute to healthy outcomes for women and infants requires clear definition of that care process. This article describes our efforts to define the theoretical construct of the nurse-midwifery care process. These efforts culminated in the development of a middle range descriptive theory of nurse-midwifery care. We share those efforts with others in the hopes of encouraging dialogue and the testing of this theory in a variety of clinical settings.

Ethics, Nursing↗
PubMedDate not supplied

Philosophy of care. A pilot study comparing certified nurse-midwives and physicians.

Certified nurse-midwives (CNMs) and physicians (MDs) are thought to differ in philosophy of pregnancy care and childbirth. However, these differences have not been documented quantitatively. This article describes and compares the beliefs and care philosophies of CNMs and MDs toward aspects of antepartum and intrapartum care of low-risk women. The sample included seven CNMs and 10 obstetricians at a large tertiary-care hospital. Using stringent statistical criteria for testing differences between the two groups, significantly more teaching was done by the CNMs than by the MDs. Other differences were all in expected directions.

Adult↗
PubMedDate not supplied

Processes of care. Comparisons of certified nurse-midwives and obstetricians.

Prenatal and intrapartum care provided to 1,181 women, all meeting risk requirements for nurse-midwifery care, by certified nurse-midwives (n = 471) and obstetricians (n = 710) are compared using indicators of physical and of educational/psychosocial components of maternity care. Data are from clinical records and questionnaires completed by the women. Bivariate analyses show that the two provider groups differ on some, but not all, processes of care. When the woman's evolving health status, personal characteristics, and preferences are controlled, there are significant differences that confirm two models of care. The nurse-midwifery approach emphasizes educational/psychosocial care and restrained, individualized use of technology. The obstetrics approach emphasizes more routine use of state-of-the-art technology. This study contributes new information to substantiate different models but also shows that both provider groups use elements of both. The difference in emphasis should encourage collaborative practice, given the shared basis for maternity care, whether it is provided by certified nurse-midwives or obstetricians.

Certification↗
PubMedDate not supplied

Clinician-specific episiotomy rates: impact on perineal outcomes.

Recent, large, randomized, controlled trials of the effects of episiotomy on perineal damage have confirmed that episiotomy is associated with an increased risk of damage to the perineum. Yet episiotomy remains the most common surgical procedure women undergo. This article examines if clinician experience, rather than scientific evidence, forms the basis for continuing this practice. Perineal outcome data are analyzed for 865 low-risk women who were attended at birth by the staff nurse-midwives or faculty obstetricians at a university-based, tertiary-care hospital. Data were collected under routine, nonexperimental conditions such that the circumstances of the labor and the clinician's preferences were allowed to determine management decisions regarding the use of episiotomy or other techniques of perineal management. Multivariate findings indicate that in the absence of episiotomy, rates of perineal integrity were highest among clinicians who usually had the lowest rate of episiotomy use. When an episiotomy was done, rates of third- and fourth-degree extensions were highest among clinicians who used episiotomy most frequently. This finding challenges the idea that clinicians who were very experienced with the use of episiotomy would avoid complications such as extensions. Future research should explore the use of nonsurgical techniques such as those employed by midwives to promote perineal integrity. Then interdisciplinary research and evidence-based education regarding these techniques can occur to improve perineal outcomes for all women.

Episiotomy↗