Biomedical subjects
Publications and source records attributed to G S Bowman.
Cardiac rehabilitation is a relatively recent development and, though it is increasingly being recognized as an important part of comprehensive cardiac care, there remains some scepticism regarding its effectiveness and some ignorance of its potential. This article reviews the literature pertaining to the effectiveness of cardiac rehabilitation for patients with coronary heart disease (CHD).
We sent a short postal questionnaire to 244 centres in England and Wales that admitted patients with cardiac conditions. In total, 199 (81%) of the centres claimed to provide a cardiac rehabilitation service. Of these, 25 were randomly selected as a representative sample and visited in order to obtain detailed information concerning the provision of services. Most (18 (72%)) of the centres had commenced their rehabilitation programme within the previous 5 years, usually at the instigation of interested staff. Patient entry to cardiac rehabilitation programmes was restricted; women (who represented only 15% of attenders), elderly people (excluded in 10 (40%) centres), and those with more complex problems, such as angina or heart failure, were under-represented. The central components of all programmes were education and exercise training but there was a wide range in the quantity and quality of service provision. Most (22 (88%)) programmes were hospital out-patient based, one (4%) was hospital in-patient based, one (4%) was community-based and one (4%) was home-based. The staffing and funding of programmes was variable, with 7 (28%) having no identified funding. There are wide variations in the resources currently available for the rehabilitation of patients with coronary heart disease. There is a need for clearer direction of these services, in particular to determine minimum service provision. Guidelines are necessary to give a framework for this relatively new and rapidly expanding service.
This paper summarises a multidisciplinary workshop convened to prepare clinical guidelines and audit standards in cardiac rehabilitation in the United Kingdom. The workshop developed a three element model of the rehabilitation process and identified needs relating to medical and psychosocial care and the potential contributions of exercise, education, secondary prevention, and vocational advice. Draft clinical standards are proposed as a basis for locally developed guidelines and further research.
The telephone is an effective means of communication and its use is growing as a means of offering members of the public access to health-care agencies for advice and support. Acute hospital beds are at a premium and as lengths of stay in hospital continue to fall there is an increasing need for effective discharge planning and post-discharge support. Eighty-five patients (58 men and 27 women) were interviewed over the telephone 1 week after discharge from a medical ward. Over half of the patients reported health problems and one-fifth reported social problems. Almost half of the patients sought advice. Telephone follow-up would appear to be a useful means of monitoring a patient's progress and providing an opportunity for patients seeking, or nurses offering, advice and support.
This study describes the development of a classification system for the clarification, understanding and measurement of nurses' work methods. The theoretical basis of the classification system is described. The system offered distinguishes between three common work methods: primary, team and task nursing; the strength of opportunity for nurse-patient interaction in each method being determined as either 'strong', 'moderate' or 'weak', according to how effectively they are practised. Preliminary testing of the system on 32 wards in 13 hospitals is described. It is concluded that further testing and possible refinement is required for validation of the system.
The attitudes of 67 student nurses towards the nursing process were studied by means of a questionnaire. Attitudes became more favourable over the 8-week study period. The results indicate that a positive environment is influential in changing the attitudes of student nurses towards the nursing process. These findings lend further support to our original work.
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The attitudes of qualified nursing staff towards the nursing process were studied. Three distinct nursing units received varying degrees of planning and education regarding the principles and practice of the nursing process. The attitudes of the nursing staff of these units were assessed by means of a 20-item questionnaire. Statistically significant differences (P less than 0.001) between the mean attitude scores for the three units were found, but comparison of the overall mean attitude scores for the three grades of nurses within each unit did not result in statistical significance (P greater than 0.35). Further analysis indicated that a structured educational programme was beneficial in creating a positive attitude towards the nursing process whereas a less structured approach had the opposite effect.
Relatives of stroke patients were asked about their knowledge and anxieties about strokes at three points in time: 72 hours after hospital admission, immediately prior to discharge, and 6 months post-discharge. During the period of hospitalization relatives were provided with information and encouraged to participate in patient care with the aim of increasing their skills in coping with the stroke patient at home. The relatives reported to be coping with the practical problems of care, but all reported problems with the emotional aspects of caring for the stroke patient.
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Cerebral blood flow (CBF), CBF responses to changes in arterial CO2 tension, and cerebral metabolic rate for oxygen (CMRO2) were measured in newborn dogs, by means of a modification of the Kety and Schmidt technique employing 133Xe. Mongrel dogs of 1-7 days of age were paralyzed and passively ventilated with 70% N2O and 30% O2. CBF was derived by analysis of paired serial 20-microliter samples of arterial and of cerebral venous blood from the superior sagittal sinus. At an arterial PCO2 of 36.9 +/- 3.7 Torr and a mean arterial blood pressure of 62 +/- 10 Torr, CBF was 23 +/- 8 ml/min per 100 g. The arteriovenous oxygen content difference averaged 5.6 vol%, and CMRO2 was 1.13 +/- 0.30 ml O2/min per 100 g. CBF increased or decreased by 0.58 ml/min/100 g per Torr change in PCO2. Our results suggest that in the newborn, basal CBF and CBF responses to CO2 are considerably lower than in the adult and parallel the lower metabolic needs of the newborn brain.
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Cerebral blood flow autoregulation (CBFA) to changes in perfusion pressure has not been previously reported in the rat. A modification of the Kety and Schmidt technique employing 133Xenon was used to measure cerebral blood flow (CBF) in paralyzed adult Sprague Dawley rats passively ventilated with 70% nitrous oxide and 30% oxygen. At a mean arterial blood pressure (MABP) of 121 +/- 19 mm Hg, and a mean arterial PCO2 of 36.2 +/- 2.9 mm Hg, mean CBF was 103 +/- 22 ml/min/100 gm of brain. CBF responses to hypercarbia were 4.9 ml/min/100 gm per mm Hg change in arterial PCO2. CBF was measured during steady state levels of hypo- and hypertension induced by phlebotomy, or by intravenous metaraminol, over the MABP range of 48-205 mm Hg. From a MABP of 80 to 160 mm Hg. CBF remained nearly constant, indicating the presence of CBFA. However, when MABP exceeded 160 mm Hg, CBF became pressure dependent, indicating a "breakthrough" of autoregulation in acute severe hypertension.