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Biomedical subjects

D Pelletier

Publications and source records attributed to D Pelletier.

At least 19 recordsLinked to original sources
PubMed2000

Multiple sclerosis: magnetization transfer MR imaging of white matter before lesion appearance on T2-weighted images.

PURPOSE: To determine the evolution of magnetization transfer (MT) in white matter regions before and after plaque development in patients with multiple sclerosis (MS). MATERIALS AND METHODS: In a 5-year longitudinal evaluation, 30 patients with MS underwent conventional magnetic resonance (MR) imaging, MT MR imaging, and clinical assessment. Cross-sectional data in 12 healthy subjects were also collected. Semiautomated lesion classification with use of T2-weighted MR images was used to measure the time course of the MT ratio (calculated with MR data acquired without and with MT saturation) in every voxel and to help analyze the relationship with the status of lesions depicted on T2-weighted images. RESULTS: There was a significant (P <.001) temporal decline in lesion MT ratio after lesion appearance on T2-weighted images. A significant (P <. 001) progressive decline in MT ratio was also present in voxels that later became lesions, prior to initial detection on T2-weighted images. Even 1(1/2) years prior to lesion appearance, the MT ratio (33.3%) in regions destined to become such lesions was significantly (P <.001) lower than that in both white matter in healthy subjects (41.3%) and other normal-appearing white matter in patients with MS (38.1%). CONCLUSION: The MT ratio reveals progressive focal abnormalities in MS that antedate by up to 2 years the appearance of lesions on T2-weighted MR images.

Adult↗
PubMed2000

Heterogeneity of T-lymphocyte function in primary progressive multiple sclerosis: relation to magnetic resonance imaging lesion volume.

We found that in vitro migration and interferon-gamma production by lymphocytes derived from primary progressive multiple sclerosis patients preselected on the basis of a high T2-weighted lesion volume (>10 cm3) on magnetic resonance imaging, were increased compared with that in primary progressive multiple sclerosis patients with a low T2-weighted lesion volume (<3 cm3) and controls. Whether the heterogeneity of immune function within the primary progressive population will correlate with response to therapy remains to be established.

Adult↗
PubMed1999

Interferon-gamma secretion by peripheral blood T-cell subsets in multiple sclerosis: correlation with disease phase and interferon-beta therapy.

Interferon-gamma (IFN-gamma) is implicated as a participant in the immune effector and regulatory mechanisms considered to mediate the pathogenesis of multiple sclerosis (MS). We have used an intracellular cytokine staining technique to demonstrate that the proportion of ex vivo peripheral blood CD4 and CD8 T-cell subsets expressing IFN-gamma is increased in secondary progressing (SP) MS patients, whereas the values in untreated relapsing-remitting (RR) MS patients are reduced compared with those of controls. Patients treated with interferon-beta (IFN-beta) have an even more significant reduction in the percentage of IFN-gamma-secreting cells. The finding that the number of IFN-gamma-expressing CD8 cells is increased in SPMS patients, a group with reduced functional suppressor activity, and is most significantly reduced by IFN-beta therapy, which increases suppressor activity, indicates that IFN-gamma secretion by CD8 T cells and functional suppressor defects attributed to this cell subset in MS can be dissociated.

Adult↗
PubMed1998

Australian nurses and device use: the ideal and the real in clinical practice.

Clinical nurses use an increasing number of technological devices when providing care. While the clinical devices themselves must undergo rigorous multidimensional assessment, it is the proficiency of the user that ultimately determines the devices' efficacy. Thus, the knowledge, skills and attitudes that nurses bring to their decision-making and use of technology are crucial elements in the technology assessment process. Technological proficiency is imperative in the current climate of rapid patient throughput in complex technological environments. This paper reports some of the findings of an Australian study, using two national Delphi panels, whose primary objective was to determine the knowledge, skills and attitudes required of expert clinicians for practice in cardiac care. Panels of 28 educators and 42 cardiac nurse clinicians completed a questionnaire indicating the importance of 107 characteristics of expert cardiac practice for both the 'real' and 'ideal' worlds of practice. Comparative results will be reported for 29 items within the thematic groups. Effective use of technology, Informed decisions regarding equipment and Critical approach to the use of technology. Both panels accepted all 29 items in these three thematic groups but indicated differences in the level of agreement on the importance of items between the 'real' and 'ideal' worlds of practice. Discussion centres around those areas where improvement is needed.

Australia↗
PubMed1997

Determining and discerning expert practice: a review of the literature.

Although the nature and characteristics of expert practice have been described in the literature, the description is incomplete. How expertise is gained is not fully understood, and definitions of expert competencies have yet to be developed. Essential issues for education arise from the demand for knowledge for expert practice. Because expertise is gained in the context of practice, expertise cannot be achieved out of context or taught as an academic exercise. A clear picture of the practice of expert nurses is necessary so that those in the profession can know and articulate expert practice and direct it to the community.

Clinical Competence↗
PubMed1997

The cardiac nurse's role: an Australian Delphi study perspective.

In Australia, as in many parts of the Western world, technological advances in healthcare have affected the roles of healthcare professionals, including nurses. Cost constraints, efficiency, and effectiveness measures also influence staffing numbers, roles, and skill mix. Specialty nurse education programs are changing, and many are moving from the hospital environment to the higher education sector. Initiatives to introduce the American Advanced Nurse Practitioner role in some environments have begun, although the current advanced practice roles are proving problematic. Specialist professional groups are striving to develop competencies or standards for practice. An understanding of what is required of expert clinicians for practice in complex technological environments such as cardiac care would be useful for both practitioners and academics. A national Delphi study was undertaken to determine what knowledge, skills, and attitudes were required of expert cardiac nurses in relation to technology in the cardiac care environments in both the "real" and the "ideal" worlds of practice. Separate panels of 28 cardiac educators and 42 cardiac nurse clinicians were given a questionnaire of 107 items and asked to indicate on a 6-point Likert scale the importance of each item to the nursing roles in both the "real" and "ideal" worlds. On the final, third round, respondents ranked the three most important items in each of the 13 thematic groups. Overall, the clinicians accepted all 107 items as important to their role, and for the majority of these they, felt that they were performing quite close to their "ideal." This article presents the 32 items for which the clinicians felt the "real" world was quite far from the "ideal" as represented by a gap of > or = 2 between the real and ideal medians. Also, despite being accepted as part of the role through the ideal scores, 21 items achieved a real world median of 3.5 or less, which indicates that in the real world these aspects of nursing are not being valued or practiced to the level clinicians would like. These two sets of items should be of greatest interest to clinicians currently in the role and to those interested in specialty education at all levels.

Australia↗
PubMed1997

The impact of the implantable cardioverter defibrillator on quality of life.

The implantable cardioverter defibrillator may prolong survival and prevent sudden cardiac arrest in patients with ventricular arrhythmias. Whereas previous research focused on mortality, attention is now turning to the impact of the device on the recipient. We reviewed the literature on the effects of the implantable cardioverter defibrillator on recipients and their families; our aim was to consolidate our current understanding and guide further research in this area. We found a number of effects on which researchers agree. Primarily, recipients are happy to have the device and generally feel more confident. However, recipients experience many psychological reactions such as fear and anxiety that can be related to the unpredictable nature of the shocks. Recipients also are affected by intellectual changes. Both recipients and their families experience similar effects and use a range of coping mechanisms; the most effective is optimism. Only one nursing intervention has been investigated that directly addresses these effects. Areas that need more research are the effects of the implantable cardioverter defibrillator during childhood, adolescence, and pregnancy; the impact of vigilance on recipients and their families; costs; and nursing interventions. More consistent, standardized quality-of-life measures are needed so that comparisons can be made between samples.

Adaptation, Psychological↗
PubMed1996

The impact of the technological care environment on the nursing role.

Proliferation of acute health care technology creates problems and benefits for nurses and patients. In this paper the impact of technology on the nursing work role is reviewed through the international literature. The thrust of the nursing literature has, not surprisingly, matured over time as the use of technology has become well established in the acute care environment, and three themes can be identified. The implications for acute care nurse specialists, including their educational needs, are set in context of the Australian health care system, with particular reference to the cardiac care environments.

Australia↗
PubMed1996

Do clinical nurse specialists and nursing unit managers believe that the provision of quality care is important?

The nursing profession has a long tradition of evaluating the quality of its product in order to ensure that the best possible care can be given. However, in the climate of economic rationalism which prevails worldwide, it is possible that the emphasis on fiscal restraint has distracted nurses from their previous focus on quality. This paper discusses the findings of two research studies designed to determine the competencies expected of nursing unit managers and clinical nurse specialists. Discussion focuses specifically on their roles in the provision of quality care.

Clinical Competence↗
PubMed1995

Diploma-prepared nurses' use of technological equipment in clinical practice.

Increasingly, nurses throughout the western world are receiving their educational preparation for initial registration in a tertiary environment at either the diploma or bachelor degree level. The length of time spent in the clinical setting has been reduced considerably, with the elimination of the apprenticeship system and the role of the student nurse as paid staff member. Concurrently, the amount of technological equipment used in the health care sector is both increasing rapidly and now found in general wards, not just the traditional 'high tech' environments. It is important to evaluate how well the tertiary experience prepares students in terms of their ability to handle common technological equipment such as infusion control devices or suction pumps. In the study reported here 245 diploma-prepared registered nurses completed a questionnaire designed to assess how nurses from tertiary institutions perceived their ability to handle technical equipment in the workplace. The majority of the respondents had been working for 7 to 12 months. No significant relationship was found between the frequency of use of specific items of clinical equipment and whether that item caused the nurse concern in practice. There was also no significant relationship between the frequency of use of an item and whether participants believed that competence should be acquired in relation to that item prior to tertiary graduation. Although moderate levels of comfort in the use of technical equipment were reported upon entry to the workplace, subjects rapidly acquired high levels of comfort in relation to equipment handling. The implications for hospital administrators and tertiary teaching programmes are discussed.

Adult↗
PubMed1995

CNSs' perceptions of role competencies: one Australian perspective.

A survey of 373 CNSs employed in hospitals in New South Wales, Australia, was undertaken to determine the competencies they believed necessary to fulfill that role. This study was designed as a sequel to a similar study of role competencies of first-line nurse managers in the same state. Factor analysis was used to identify a variety of role dimensions. Results indicate that CNSs perceive their role as extremely comprehensive, yet a significant potential to overlap with the role of managers was evident. In addition, some interesting features of the CNS role emerged that may generate both professional approval and concern. The strength of the respondents' acceptance of competencies that link their clinical role to activities that directly influence the quality of care is heartening; however, a number of clinically based competencies, including some of those related to patient care management or quality of care, either loaded weakly or did not load at all on the factor structure. Concern may be felt regarding the claim of these specialized clinicians to competencies traditionally seen as strongly associated with the managerial role. Should specialist clinicians take on too many managerial functions, significant role overload could result, and affect quality care provision.

Attitude of Health Personnel↗
PubMed1995

A profile of the clinical nurse specialist in one Australian state.

The nursing profession in Australia implemented progressively in each state new clinical career structures commencing in 1986. While the structures differ, all states introduced the position of CNS. The role and responsibilities associated with this position also differ. The role of CNS in Australia is different from that described in the North American literature. Findings of a study that established a profile of CNSs in the heavily populated state of New South Wales are described. Data on education, experience, and career plans were obtained from 373 CNSs in 19 hospitals. The results enable some comparison with first-line nurse managers whose role is very similar to the American position of head nurse. As with their managerial counterparts, the Australian CNSs' lack formal educational preparation and were demonstrating a low rate of participation in educational programs at the time of the study. However, 82% of respondents intended to remain in clinical practice. This is significant since this was a major goal in development of a clinical career structure.

Adult↗
PubMed1995

How should enzyme activities be used in fish growth studies?

The activity of glycolytic and oxidative enzymes was monitored in the white muscle of Atlantic cod Gadus morhua experiencing different growth rates. A strong positive relationship between the activity of two glycolytic enzymes and individual growth rate was observed regardless of whether the enzyme activity was expressed as units per gram wet mass, units per gram dry mass or with respect to muscle protein and DNA content. The most sensitive response to growth rate was observed when pyruvate kinase and lactate dehydrogenase activities were expressed as units per microgram DNA, and this may be useful as an indicator of growth rate in wild fish. In contrast, no relationship between the activities of oxidative enzymes and growth rate was observed when cytochrome c oxidase and citrate synthase activities were expressed as units per gram protein. Apparently, the aerobic capacity of white muscle in cod is not specifically increased to match growth rate.

Journal Article↗
PubMed1994

The effects of graduate nurse education on clinical practice and career paths: a pilot study.

The recent proliferation of graduate courses in nursing has increased the need for educational administrators to evaluate the impact of such programmes on clinical practice and the career of participants. 40 registered nurses undertaking graduate studies were surveyed as a pilot for an extensive longitudinal study of their perception of the effects of study on work performance and career opportunities. Overall, positive effects were noted by respondents on their job satisfaction, self-esteem, professional thinking and career moves. Increases in professional behaviours such as mentoring, research and writing for publication were noted. Negative consequences were noted by a minority and were related to alterations to health status and increased levels of stress.

Career Mobility↗
PubMed1994

Role overlap between clinical nurse specialists and nursing unit managers.

Role ambiguity is a serious and costly phenomenon that the healthcare delivery system can ill afford. Classically, it results from a lack of clarity or information concerning the expectations of a role, and it often results in several staff members undertaking the same activities. The resultant inefficiencies are costly to the organization because job satisfaction decreases and the number and quality of applicants for positions decline because people are unsure about the role and its functions. The authors describe an example of role ambiguity that resulted when the new classifications of nursing unit manager and clinical nurse specialist were introduced in New South Wales, Australia, in 1986.

Hospital Units↗
PubMed1993

The focused use of posters for graduate education in the complex technological nursing environment.

Posters are increasingly recognised as both a method of professional communication and a strategy for learning and assessment in nurse education. Rapid technological developments in health care and the nursing practice environment are generating specific educational needs in relation to the use of technology. There is a move to incorporate within the traditional rational technical focus a broader, more comprehensive understanding of technology, technological equipment and procedures. Technological innovations are an ideal subject matter for poster presentations at the graduate level particularly as broader dimensions such as the impetus for introduction, the research base, the evaluation strategy and the cost can be incorporated. Each poster can become a teaching focus for a student presentation to classmates or other professional forums in order to catalyse discussions of these wider dimensions. A description of the use of posters for these purposes with examples and comments by participants is included.

Audiovisual Aids↗
PubMed1993

Hematopoietic progenitor content of fetal cord blood collected using citrate-phosphate-dextrose: influence of holding temperature and delays.

Storage of unseparated fetal cord blood collected into citrate-phosphate-dextrose (CPD) for 48 hours has been studied using progenitor cell assays [plasma clot technique with plasma-conditioned medium, erythropoietin (EPO), erythropoietin + IL-3 as growth factors]; collected fetal blood volume was low [61 +/- 4 ml, mean +/- 95% confidence interval (CI)]. The CFU-GM concentration in total cord blood was 2460 +/- 1476 CFU-GM/ml, comparable to normal bone marrow collected into medium RPMI + heparin (2350 +/- 1258); 2 of 12 samples contained fewer than 10(3) CFU-GM. Storage of unseparated cord blood CFU-GM in CPD was better at 4 degrees C (rapid decrease at day (D) 2 from 15 +/- 9 x 10(4) at D0; 14 +/- 11 x 10(4) at D1 to 6 +/- 4 x 10(4) at (D2) than at 22 degrees C (strong decrease since D1: 5 +/- 4 x 10(4) CFU-GM). The CFU-GEMM content remained steady at 4 degrees C: from 16 +/- 16 x 10(4) at D0 to 18 +/- 16 at D2. Cryopreservation and thawing of unfractionated cord blood at D0 did not affect the CFU-FM cloning rates. Whether mature progenitors are more affected than stem cells by storage in CPD remains to be determined.

Adult↗