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Biomedical subjects

G Harvey

Publications and source records attributed to G Harvey.

At least 19 recordsLinked to original sources
PubMed1999

Obturator neuropathy. An anatomic perspective.

Entrapment of the anterior division of the obturator nerve is a recently described cause of medial groin pain. This anatomic study examines the extrapelvic course of the nerve and related fascia in the adductor region to provide an anatomic basis for the syndrome and to aid in surgical treatment. Twelve anatomic specimen limbs were dissected to document the extrapelvic course of the obturator nerve, the myofascial arrangement, and the vasculature. A thirteenth limb was prepared with intraarterial glycerin to examine the vessels in more detail. A distinct fascial plane was found deep to the adductor longus and pectineus overlying the anterior division of the obturator nerve. The arterial supply to the adductor muscles is related intimately to the nerve and its branches, with associated local thickening of the fascial connective tissue. The relationship between the nerve, vessels, and fascia appears sufficient to result in an entrapment syndrome. The anatomic findings from this series will help plan the surgical treatment of this condition.

Cadaver↗
PubMed1998

Enabling the implementation of evidence based practice: a conceptual framework.

The argument put forward in this paper is that successful implementation of research into practice is a function of the interplay of three core elements--the level and nature of the evidence, the context or environment into which the research is to be placed, and the method or way in which the process is facilitated. It also proposes that because current research is inconclusive as to which of these elements is most important in successful implementation they all should have equal standing. This is contrary to the often implicit assumptions currently being generated within the clinical effectiveness agenda where the level and rigour of the evidence seems to be the most important factor for consideration. The paper offers a conceptual framework that considers this imbalance, showing how it might work in clarifying some of the theoretical positions and as a checklist for staff to assess what they need to do to successfully implement research into practice.

Evidence-Based Medicine↗
PubMed1998

School nurse web authoring.

Many school nurses are now surfing the World Wide Web for clinical and professional information. The Web is also a tool for providing professional services and delivering nursing care. Three applications for school nursing are featured: using the Web for professional publishing, a state association web page, and a school nurse office website.

Authorship↗
PubMed1997

Four cases of aggressive MRSA wound infection following head and neck surgery.

Four cases of serious MRSA wound infection following head and neck surgery have been identified. One patient died. At post mortem a mediastinal abscess containing MRSA was found to have eroded into the innominate artery causing fatal haemorrhage. The other three suffered serious wound infections, two requiring further surgery. Once MRSA had been identified they were treated with intravenous teicoplanin and all made a full recovery.

Adult↗
PubMed1997

Practitioner based quality improvement: a review of the Royal College of Nursing's dynamic standard setting system.

OBJECTIVE: To explore and describe the implementation of the Royal College of Nursing's approach to audit--the dynamic standard setting system--within the current context of health care, in particular to focus on how the system has developed since its inception in the 1980s as a method for uniprofessional and multiprofessional audit. DESIGN: Qualitative design with semistructure interviews and field visits. SETTING: 28 sites throughout the United Kingdom that use the dynamic standard setting system. SUBJECTS: Quality and audit coordinators with a responsibility for implementing the system; clinical staff who practice the system. MAIN MEASURES: Experiences of the dynamic standard setting system, including reasons for selection, methods of implementation, and observed outcomes. RESULTS: Issues relating to four themes emerged from the data: practical experiences of the system as a method for improving patient care; issues of facilitation and training; strategic issues of implementation; and the use of the system as a method for multiprofessional audit. The development of clinical practice was described as a major benefit of the system and evidence of improved patient care was apparent. However, difficulties were experienced in motivating staff and finding time for audit, which in part related to the current format of the system and the level of training and support available for clinical staff. Diverse experiences were reported in the extent to which the system had been integrated at a strategic level of quality improvement and its successful application to multiprofessional clinical audit. CONCLUSIONS: The Royal College of Nursing's dynamic standard setting system can successfully be used as a method for clinical audit at both a uniprofessional and multiprofessional level. However, to capitalise on the strengths of the system, several issues need to be considered further. These include modifications to the system itself, as well as a more strategic focus on resources and support for audit, better integration of quality initiatives in health care, and a continuing focus on ways to achieve true multiprofessional collaboration and involvement of patients in clinical audit.

Evaluation Studies as Topic↗
PubMed1997

Characterization of antinucleolar antibody reactivity in patients with systemic sclerosis and their relatives.

OBJECTIVE: To study the prevalence and specificity of antinucleolar antibodies (ANoA) in patients with systemic sclerosis (SSc), their spouses, and their first-degree relatives, and to investigate whether SSc family members have greater frequency of ANoA than expected. METHODS: The sera of 58 SSc probands, 4 first-degree relatives with SSc, 215 first-degree relatives without SSc, and 24 spouses were screened for ANoA by indirect immunofluorescence (IF), and nucleolar antigens were characterized by immunoprecipitation (IP) of 35S methionine labeled K562 cell extracts. Sera from 118 randomly chosen family members without SSc were separately compared with 120 age and sex matched blood donor controls. RESULTS: Antinucleolar reactivity was detected by IF in 25 patients with SSc (40.3%), in 33 non-SSc relatives (15.3%), and in 4 spouses (16.7%). Twenty-four sera had autoantibodies to defined nucleolar antigens by IP (seven Pm-Scl, ten RNA polymerase (pol) I, four U3 RNP, three Th RNP), and all were from patients with SSc (38.7%). No serum had more than one type of nucleolar-specific autoantibody. Four sera had autoantibodies to topoisomerase I (topo I) and RNA pol II, one of which also recognized RNA pol I and RNA pol III. Antinucleolar IF was significantly more common in the unaffected first-degree relatives of patients with SSc (18.1%) than in controls (8.3%; p < 0.05). A small number of sera from both relatives and controls recognized bands by IP, none of which was identified as a SSc-specific autoantigen. CONCLUSION: Although antinucleolar reactivity is more common in the first-degree relatives of patients with SSc than controls, SSc associated ANoA are only present in patients with the disease, and appear to be mutually exclusive.

Antibodies, Antinuclear↗
PubMed1996

Achieving improvement through quality: an evaluation of key factors in the implementation process.

Quality, audit and standard setting are major issues on the present day nursing and health care agenda. Considerable time, energy and resources have been invested in developing and implementing a range of different quality and audit systems, yet there is limited evidence to date to suggest that they are having any significant impact in terms of changing practice and improving patient care. This paper will present the results of a study undertaken to evaluate the implementation of three of the most common nursing quality systems used in the United Kingdom: Monitor, Qualpacs and the dynamic standard setting system (DySSSy). In each case, the focus was on identifying key factors in the process of implementation that could predict positive programme outcomes--defined in terms of acceptance by clinical nursing staff and perceived impact on the quality of patient care. The study adopted a three-stage evaluation design, with three distinct levels of investigation and analysis, and utilized a range of descriptive and exploratory methods. In total, 14 sites implementing one of the three nursing quality systems were studied. Additional data, derived from individuals' experiences of implementing quality in nursing, were used to enhance and validate the findings. The results indicated a number of important system-related, contextual and practical issues of implementation. These were underpinned by two key factors, defined as ownership for quality and action to improve. However, most present day nursing quality programmes appear to be failing to embrace these two concepts simultaneously. The paper will conclude by discussing the implications of these findings for future developments in nursing and health care quality improvement.

Attitude of Health Personnel↗
PubMed1996

Quality in health care: traditions, influences and future directions.

In tracing developments in health care quality, a number of different approaches to quality evaluation can be identified, differing in terms of the specific focus and means of achieving quality. This paper attempts to classify the development of quality in health care, drawing on experiences within the industrial quality movement. Three distinct models of quality evaluation are described, according to whether they define quality at an individual level, as an exercise in inspection, or as a method for continuous improvement. Developments in quality and audit in health care are explored in relation to the models and specific experiences within nursing and medicine are compared. The need to be aware of the history of quality within specific professional groups is highlighted, particularly within the context of future developments in health care quality and the growing focus on multi-professional collaboration.

Forecasting↗
PubMed1996

From research to practice: one organizational model for promoting research-based practice.

This paper describes a framework used by the National Institute for Nursing in Oxford to integrate research, development and practice. With the increasing attention given to the topic of how research findings are implemented into clinical practice, it was felt important to share the challenges that have arisen in attempting to combine traditional research activities with more practice-based development work. The emerging conceptual framework, structures and functions are described, highlighting the variety of partnerships to be established in order to achieve the goal of integrating research into practice. While the underpinning principles of the framework-generating knowledge, implementing research into practice and evaluating the effectiveness of programmes-are not new, it is the way they have been combined within an organizational structure that could be helpful to others considering such a strategy. Both the strengths and weaknesses of the framework are discussed, a number of conclusions drawn as to its robustness and consideration given to its replication.

Diffusion of Innovation↗
PubMed1995

The high vaginal swab in general practice: clinical correlates of possible pathogens.

Clinical features, diagnosis and treatment of 286 women whose high vaginal swabs (HVS) submitted by their general practitioners showed pure, heavy growth of Staphylococcus aureus, beta haemolytic streptococci groups A, C or G, Streptococcus milleri, Streptococcus pneumoniae or Haemophilus influenzae were analysed. Women with group A, C and G streptococci frequently had clinical vulvovaginitis and although the numbers were too small for statistical confirmation, S. pneumoniae and H. influenzae appeared to cause clinical disease as well. The association of S. aureus or S. milleri with clinical vulvovaginitis was much less convincing. It seems relevant for laboratories to report sensitivities for group A, C and G streptococci. Further research is needed to determine the pathogenicity of S. pneumoniae and H. influenzae.

Adolescent↗
PubMed1995

Quality improvement of nursing care in hospitals in India: the dynamic approach.

A workshop was held in Calcutta in August 1992 by the Nurses' Research Society of India (NRSI), in partnership with the Royal College of Nursing of the UK, Dynamic Quality Improvement Programme (DQIP), to introduce an approach to quality improvement to nurses in India interested in evaluating and improving the care they provide. Since then, three sites have implemented the system for standard setting and audit (Dynamic Standard Setting System) which is the method for evaluating care used within that approach. An appraisal of the progress of the sites to date indicates that, in the clinical setting, nurses are progressing well with the writing of standards and have experienced little difficulty in understanding the theory and processes involved. They are currently revising the standards written with a view to implementing them and auditing them in the near future. This article outlines the introduction of dynamic quality improvement and the Dynamic Standard Setting System to the nurses in India and describes the progress of one of the test-sites currently working on its implementation.

Group Processes↗
PubMed1995

Protein binding and serum bactericidal activities of vancomycin and teicoplanin.

In a randomized crossover study, the protein binding and serum bactericidal activities (SBAs) of vancomycin and teicoplanin against Staphylococcus aureus and Streptococcus pyogenes were investigated in six healthy volunteers. Total concentrations in serum 1 h postadministration of vancomycin and teicoplanin were 25.5 +/- 2.7 and 10.8 +/- 8.9 mg/liter, respectively; mean free concentrations were 14.6 +/- 2.0 and 0.6 +/- 0.9 mg/liter, respectively. Protein binding for vancomycin was 36.9% +/- 2.87%, and that for teicoplanin was 97.4% +/- 2.6%. SBA determined in pooled human serum at 1 h against S. aureus ranged from 1:8 to 1:32 for both vancomycin and teicoplanin. Against S. pyogenes SBA at 1 h ranged from 1:16 to 1:128 for vancomycin and 1:256 to 1:2,048 for teicoplanin. In vitro kill curve studies showed that vancomycin is slowly bactericidal and that teicoplanin is bacteriostatic. Despite having less in vitro cidal activity against the study isolates and having low or unrecordable levels of free drug in serum, teicoplanin demonstrated a similar or better SBA than vancomycin. SBA was more closely related to the total drug level (r = 0.77 for S. aureus and r = 0.79 for S. pyogenes) than the free level of teicoplanin (r = 0.59 for S. aureus and r = 0.56 for S. pyogenes). The high level of protein binding of teicoplanin did not seem to impair its antibacterial activity as measured by its SBA.

Adult↗
PubMed1994

Anti-topoisomerase I antibodies in silica-associated systemic sclerosis. A model for autoimmunity.

OBJECTIVE: To determine the frequency and type of autoantibodies present in patients with systemic sclerosis (SSc) associated with an established environmental toxin. METHODS: Clinical data and sera were available from 14 men with silica-associated SSc who had developed SSc after at least 2 years of exposure to silica at work. Controls included 27 men with silicosis without SSc. Autoantibodies were measured by immunodiffusion, immunoblotting, and functional inhibition of topoisomerase I (topo I). RESULTS: Nine of the 14 patients with silica-associated SSc had anti-topo I antibodies. All anti-topo I antibodies in the patients with silica-associated SSc and in 14 anti-topo I-positive patients with idiopathic SSc were directed at an active site of topo I, or at least sterically inhibited its function. One patient with silica-associated SSc had anticentromere antibodies. Unexpectedly, 2 patients with silicosis who had no symptoms of a connective tissue disease had autoantibodies to Ro/SS-A and La/SS-B autoantigens. CONCLUSION: Anti-topo I antibodies are the predominant autoantibodies present in silica-associated SSc. The generation of anti-topo I antibodies in genetically susceptible individuals may depend partly on the patient's sex and on the site of organ involvement, and may be triggered by silica particles acting as an immune adjuvant.

Aged↗
PubMed1994

HLA-DQB1 associations with anti-topoisomerase-1 antibodies in patients with systemic sclerosis and their first degree relatives. United Kingdom Systemic Sclerosis Study Group.

The frequency and functional properties of anti-topoisomerase-1 antibodies (ATA) have been studied in 58 systemic sclerosis (SSc) probands, 218 first degree relatives and 22 spouses. The dependence of ATA on the presence of certain HLA-DRB1 and HLA-DQB1 alleles was examined. ATA were detected by immunodiffusion, by absorption or inhibition of topoisomerase-1 enzymic activity, by immunoblotting of a K562 cell extract and by immunoprecipitation of 35S radiolabelled cell lines. HLA class II typing for HLA-DRB1 and HLA-DQB1 was performed by oligonucleotide typing in 49 families. Six probands and two relatives had ATA. The relatives with ATA had SSc. All eight individuals with ATA directly inhibited topoisomerase-1 function. Four of the eight had limited skin disease and four had diffuse skin involvement. The seven who were genotyped had at least one HLA-DQB1 allele encoding for tyrosine at position 30 of the first domain. Therefore, ATA are not widely dispersed within families, but rather are only present in those with SSc, and certain genetic requirements appear necessary for their generation.

Alleles↗
PubMed1994

Criteria formulation and application: an evaluative framework.

This paper critically examines how criteria are formulated and applied in quality assurance or quality improvement systems. It begins by drawing attention to the division that exists between criteria derived by so-called expert groups and those developed more locally by practitioners. In seeking to analyse the strengths and weaknesses of these two contrasting approaches, it explores the more fundamental questions of how criteria are formulated in general and how they can best be applied. An evaluative framework is offered as a working checklist for practitioners involved in criteria formulation. The framework identifies three main areas: actual construction of criteria; procedures for formulation and issues related to application. An example of each area is offered from results of the ODySSSy Project. The paper concludes by recommending more systematic studies in this highly complex area.

Delphi Technique↗
PubMed1994

Cutaneous cryptococcal infection without immunodeficiency.

A case of cutaneous cryptococcosis (encapsulated strain) in a 67-year-old female, with no evidence of immune suppression (normal cell surface marker analysis and mitogen proliferation studies) and which responded to treatment with oral fluconazole is reported. To date her clinical progress remains satisfactory after 12 months of follow-up.

Aged↗