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Biomedical subjects

Daniel Kelly

Publications and source records attributed to Daniel Kelly.

At least 19 recordsLinked to original sources
PubMed2004

Male sexuality in theory and practice.

Male sexuality is a complex phenomenon shaped by personal, cultural,and social factors. This article has argued that male sexual function is an important consideration in conditions such as prostate cancer. There are surely other conditions where it is understood even more poorly. Although theorists tend to explore male sexuality in relation to vague concepts such as power, phallocentrism, and aggression, sexuality becomes a personal reality in illness contexts. Using insights from a study into prostate cancer, it has been suggested that men assess embodied risks, such as impotence, in highly individual ways. The uncertainty that characterizes this cancer further compounds the difficulties involved, despite attempts of professionals to provide adequate levels of information and support. Researchers and practitioners alike should begin to question the gap between theoretical constructions of male sexuality and its reality in healthcare situations. More attention should be paid to understanding the importance of sexual function for men who are living with conditions such as prostate cancer. Those men who face up to the threat of such embodied changes, and who learn to cope with physical and emotional (and sexual) vulnerability, may learn to evaluate their lives in new ways. As Kenneth, one of the participants in this study said of his experience of cancer, "It just seems unnecessary for them to have to go through that to learn and understand themselves and be honest with themselves about what is really important."

Adaptation, Psychological↗
PubMed2004

Achieving change in the NHS: a study to explore the feasibility of a home-based cancer chemotherapy service.

A major focus of current health policy in the United Kingdom is the development of services that meet the public's expectations. To achieve this there is a need to evaluate current provision to ensure that the best use is made of finite resources. The study reported here adopted an interview approach to examine an existing outpatient chemotherapy service, and to consider the feasibility of introducing a home based model. Following a review of literature on this topic data were obtained from in-depth interviews with patients and professionals regarding the present service. These were then combined with an analysis of service contracts and financial estimates. The poor quality of much of the cost-related information limited the conclusions which could be drawn, and emphasised the need for access to more accessible and robust financial information upon which to base change. The study also illustrated the benefits of feasibility studies; especially when cost-effectiveness and patient satisfaction are the driving forces behind proposed changes to clinical services.

Ambulatory Care↗
PubMed2004

Examining the validity of pressure ulcer risk assessment scales: a replication study.

Risk assessment scales (RASs) intended to identify patients most at risk of developing pressure ulcers have been widely used for many years. Numerous studies have evaluated their predictive validity but potential bias has been inherent in the design of all. To overcome these problems a simulation study was conducted in which clinical nurses were asked to identify the degree of risk experienced by four patients employing the three RASs discussed most frequently in the literature (Norton, Braden and Waterlow Scores). These findings were compared with nurses' clinical judgment rated on a visual analogue scale. The simulations consisted of high-resolution photographs accompanied by case studies of the patients. The nurses' scores were compared to estimates of risk generated by an expert panel. Nurses' clinical judgment agreed much more closely with expert opinion than any of the RASs. A replication study was undertaken to confirm these findings. One hundred and fifteen nurses participated in replication. Again the nurses' clinical judgment matched expert opinion much more closely than the results of the RASs. Replication also drew attention to a number of methodological issues which deserve consideration when using simulation to test the effectiveness of clinical tools and the need to establish adequate measures of external validity whenever use of this method is contemplated.

Bias↗
PubMed2004

Training needs analysis. A literature review and reappraisal.

Training needs analysis is the initial step in a cyclical process which contributes to the overall training and educational strategy of staff in an organisation or a professional group. The cycle commences with a systematic consultation to identify the learning needs of the population considered, followed by course planning, delivery and evaluation. Although much has been written about training needs analysis in relation to post-registration nursing education, there is disagreement concerning its impact on the training cycle and its potential to influence service delivery. This stimulated the literature review presented below. Initial searches of nursing databases identified 266 works. Twenty three (8.6%) contained empirical findings relating to post-registration nursing education in which assessment of training needs was presented as the major aim. Most of these accounts were concerned with the training needs of nurses in more than one organisation and were classified as macro-level training needs analysis. However, seven studies were concerned with a single, specific organisation (micro-level training needs analysis). Despite their smaller scale and more limited scope, micro-level training needs initiatives demonstrated greater methodological rigour, were more likely to consider the stakeholder perspective, to generate findings which could positively influence the rest of the training cycle and showed the greatest potential for influencing service delivery and quality of patient care. The review drew attention to the similarities between the training cycle and the audit cycle and resulted in the development of a model which could be used to evaluate the effectiveness of the process and outcomes of future training needs analysis initiatives.

Data Collection↗
PubMed2004

'Being in the same boat': ethnographic insights into an adolescent cancer unit.

Cancer may be considered a particularly challenging diagnosis for adolescents. Treatment for adolescents in the United Kingdom may be provided in paediatric or adult settings or, more rarely, in specialist adolescent cancer units. An ethnographic approach was adopted to gather 'insiders' views of one such unit using in-depth interviews with patients, parents and professionals, as well as non-participant observation of key events. Two data themes 'cancer and the cancer unit' and 'changes over time' are discussed in this paper. Benefits of the unit included shared understandings and the manner in which the privations of adolescent cancer were contained and managed by those involved.

Adaptation, Psychological↗
PubMed2004

The impact of commissioning processes on the delivery of continuing professional education for cancer and palliative care.

Educational commissioning was introduced into nursing and non-medical education in the mid 1990s. However, little research has been undertaken to explore its effect on continuing professional education despite early concerns that it could have a negative impact, especially in relation to more specialist provision such as that required by nurses delivering cancer and palliative care. The in-depth, qualitative study reported in this paper examined the commissioning process and how it was perceived by key stakeholders in one Workforce Development Confederation and the two universities which provided the education for practitioners throughout a local Cancer Network. The study identified failure to address educational needs accurately because too little attention was given to training needs analysis at the level of National Health Service Trusts. Commissioning was dominated by the need to demonstrate value for money at the expense of educational innovation and there was scope for improving communication between stakeholders. In addition scope existed for better collaboration between the two provider universities. Although all respondents voiced the similar criticisms, lecturers, service managers and Trust education leads were more able to suggest solutions to problems than education managers because of their awareness of service needs and the requirements of individual practitioners. The findings of this study cannot be generalised beyond the Cancer Network in which it took place. However, they clearly indicate possible weaknesses in the commissioning process which should be explored in greater depth, in relation to continuing professional education for specialist and non-specialist areas of practice.

Attitude of Health Personnel↗
PubMed2003

Adolescent cancer--the need to evaluate current service provision in the UK.

This article suggests that service provision for adolescents with cancer requires further attention by health service researchers. Evidence of the care needs of this patient group remains scarce, particularly in terms of evaluations of the available care settings in the UK. The authors discuss the challenges facing the adolescent cancer patient population, and discuss the findings from a recent ethnographic evaluation of one of the first specialist UK units dedicated to the care of adolescents with cancer. The implications for further evaluative research, education and staff-related concerns are explored in the light of the findings.

Adolescent↗
PubMed2003

Persistently low extracellular glucose correlates with poor outcome 6 months after human traumatic brain injury despite a lack of increased lactate: a microdialysis study.

Disturbed glucose brain metabolism after brain trauma is reflected by changes in extracellular glucose levels. The authors hypothesized that posttraumatic reductions in extracellular glucose levels are not due to ischemia and are associated with poor outcome. Intracerebral microdialysis, electroencephalography, and measurements of brain tissue oxygen levels and jugular venous oxygen saturation were performed in 30 patients with traumatic brain injury. Levels of glucose, lactate, pyruvate, glutamate, and urea were analyzed hourly. The 6-month Glasgow Outcome Scale extended (GOSe6) score was assessed for each patient. In regions of increased glucose utilization defined by positron emission tomography, the extracellular glucose concentration was less than 0.2 mmol/l. Extracellular glucose values were less than 0.2 mmol during postinjury days 0 to 7 in 19% to 30% of hourly samples on each day. Transient decreases in glucose levels occurred with electrographic seizures and nonischemic reductions in cerebral perfusion pressure and jugular venous oxygen saturation. Glutamate levels were elevated in the majority of low-glucose samples, but the lactate/pyruvate ratio did not indicate focal ischemia. Terminal herniation resulted in reductions in glucose with increases in the lactate/pyruvate ratio but not in lactate concentration alone. GOSe6 scores correlated with persistently low glucose levels, combined early low glucose levels and low lactate/glucose ratio, and with the overall lactate/glucose ratio. These results suggest that the level of extracellular glucose is typically reduced after traumatic brain injury and associated with poor outcome, but is not associated with ischemia.

Adult↗
PubMed2002

Establishing the validity of pressure ulcer risk assessment scales: a novel approach using illustrated patient scenarios.

Preventing pressure ulcers is an important nursing goal and over the years a number of risk assessment scales (RASs) have been developed to expedite clinical judgement. The aim of this study was to examine the validity of the three most commonly used RASs compared to nurses' own clinical judgement. Patient simulations were presented to 236 clinical nurses. Nine hundred and forty one assessments were completed and compared to the ratings from a panel of tissue viability experts. Clinical judgement exactly matched expert opinion (69.1%) more often than assessment with any of the RASs. The Waterlow Score matched exactly in 20% of cases, the Braden Scale in 8.5% of cases and the Norton Score in 4.6% of cases. Thus none of these RASs can be considered valid, assuming that the expert panel genuinely reflected the 'gold standard' in terms of the external criterion. The implications for clinical practice are far-reaching considering the extent to which RASs are currently used to reach important clinical decisions relating to the deployment of expensive pressure-relieving aids and nursing time.

Humans↗
PubMed2002

An action research project to evaluate the clinical practice facilitator role for junior nurses in an acute hospital setting.

It has been well documented that newly qualified nurses require support in developing confidence and professional competence. Although preceptorship models have gone some way in addressing this need, innovative and flexible models of facilitation and development are also required to respond to local demands. In the project reported here a number of supernumerary clinical practice facilitators (CPFs) were appointed to support both healthcare assistants and newly qualified registered nurses to enhance their competence and clinical skills. It was anticipated that they might also encourage awareness of other professional issues, such as evidence-based practice, as well as having a positive influence on the clinical learning environment and staff morale. This article describes how an action research approach was used to establish the CPF role in a variety of clinical areas across a large inner-city National Health Service Trust. It outlines the evaluation undertaken and the further contribution that such roles could provide.

Clinical Competence↗
PubMed2002

The implications of improvements in screening for prostate cancer.

With Men's Health Week running from 10 to 16 June this year, there is an increasing focus on men's health. Prostate cancer may be traditionally associated with elderly men, but with improvements in screening techniques increasing numbers of patients are being diagnosed at a younger age, perhaps changing the view of this disease.

Adult↗
PubMedDate not supplied

Training needs analysis: an evaluation framework.

Training needs analysis (TNA) is the first step in the training and educational strategy of an organisation and is crucial to meeting the continuing professional development needs of the healthcare workforce and service. TNA must be carefully planned, conducted and have clear outcomes to ensure that training interventions are implemented effectively and that they lead to meaningful changes in service delivery. However, there is a death of literature on approaches to critique TNA. This article describes a framework developed specifically to evaluate the effectiveness of TNA. The framework combines approaches that have been used to evaluate conventional research studies and audit.

Attitude of Health Personnel↗