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Biomedical subjects

J Donoghue

Publications and source records attributed to J Donoghue.

At least 19 recordsLinked to original sources
PubMed2004

Dwell time and functional failure in percutaneous endoscopic gastrostomy tubes: a prospective randomized-controlled comparison between silicon polymer and polyurethane percutaneous endoscopic gastrostomy tubes.

BACKGROUND: Silicone percutaneous endoscopic gastros-tomy (PEG) tubes are associated with more short-term complications and possibly fail sooner than those made of polyurethane. Understanding the deterioration and long-term complications leading to tube failure has important clinical and cost implications. AIM: To compare dwell time and patterns of failure ofsilicone polymer and polyurethane PEG tubes. METHODS: Participants randomized to receive a siliconepolymer (n = 76) or polyurethane (n = 62) PEG werevisited monthly for 540 days, until death or tube removal. Tube and exit site characteristics and reasons for removal were recorded. RESULTS: Tube failure occurred in 25% of silicone PEGs and 12.9% of polyurethane PEGs. Mean tube survival for silicone PEGs was 377.2 days (CI: 326-428) and for polyurethane 436.8 days (CI: 383-490; P = 0.13). A greater proportion of silicone PEGs developed intralumenal colonization and altered tube integrity than polyurethane (P < 0.001). Silicone PEGs blocked more frequently (P < 0.005) and were removed because of irreversible blockage more often than polyurethane PEGs (P < 0.05). Silicone PEGs with reversible blockage and tube integrity changes had a significantly greater probability of failure than silicone tubes without these changes (P < 0.005 and P < 0.05, respectively). CONCLUSIONS: Observations over time indicate that sili-cone PEGs are more susceptible than polyurethane PEGs to tube deterioration, resulting in substantially increased management demands to sustain patients' feeding and medication schedules.

Adult↗
PubMed2003

Superparallel holographic correlator for ultrafast database searches.

We describe a superparallel holographic optical correlator that performs two-dimensional spatial and angular multiplexing simultaneously. The key step in this architecture is the use of a holographic multiplexer to split a query image into many copies before it applies them to the holographic database. A holographic demultiplexer, in conjunction with an aperture, is used to identify the location and the angle of the brightest correlation peak. This architecture uses only O(square root of N) detector elements to search through N unsorted images in a single query. We demonstrate the basic features of this architecture, using three spatial locations with eight angle-multiplexed images in each location.

Journal Article↗
PubMed2001

Prenatal diagnosis of two rare de novo structural aberrations of the Y chromosome: cytogenetic and molecular analysis.

Two rare de novo structural aberrations of the Y chromosome were detected during routine prenatal diagnosis: a satellited non-fluorescent Y chromosome (Yqs), the first de novo Yqs to be reported in a fetus, and a terminal deletion of the Y chromosome long arm del(Y)(q11). In both cases detailed cytogenetic and molecular analyses were undertaken. In the case of the Yqs it was demonstrated by fluorescence in situ hybridization (FISH) that the satellites were derived from chromosome 15. In the case of the del(Yq), it was shown with molecular analysis by polymerase chain reaction (PCR) amplification of sequence-tagged sites (STS-PCR) that the deleted portion of the long arm of chromosome Y included the azoospermia factor loci, AZFb and AZFc. The clinical significance of these findings is discussed.

Adult↗
PubMed2001

Critical care dependency tool: monitoring the changes.

The critical care patient dependency system (CCPD) is a factorial patient acuity system developed in 1993 by Ferguson and Harris-Ingall' for use in adult critical care areas. It was developed specifically to help determine Australian nursing cost weights and was utilised to collect data from nine Sydney critical care units from October 1992 until May 1993. The St. George Hospital (SGH) general intensive care unit, one of the nine participating hospitals, continues to use and collect data with the CCPD. This paper describes the instrument and compares data on Australian national diagnosis related groups (ANDRGs), collected during the original study, to ANDRG information on the critical care population 3 and 6 years later. In addition, the paper examines and compares the demographics of the SGH critical care patient population, patient acuity (based upon CCPD patient scores) and intensive care nursing clinical practices collected over a 3 month period in 1996 and again in 1999. Demographic and patient acuity data for SGH in 1993 are unavailable and so comparisons were unable to be made. The findings demonstrate changes in the management of critically ill patients, especially in relation to ventilation management, wound care and invasive monitoring practices; this resulted in shifts to the nursing workload. For this reason, the instrument is useful in providing nurse managers with information about patient dependencies and nursing work.

Critical Care↗
PubMed2001

Managing ventilatory insufficiency and failure in a patient with kyphoscoliosis: a case study.

This article reports a case study of 'Sue', a 37 year old female who was transferred to a metropolitan hospital's intensive care unit in acute respiratory failure secondary to severe kyphoscoliosis (KS). KS is defined as a deformity of the spine involving both lateral displacement (scoliosis) and anteroposterior angulation (kyphosis). Over time, this anatomical distortion results in ventilatory insufficiency due to muscle weakness. Sue displayed a restrictive lung pattern, evidenced by a decreased vital capacity and tidal volume with severe nocturnal dyspnoea, resulting in raised carbon dioxide levels in arterial blood and decreased oxygenation. This paper reviews Sue's progress throughout her hospitalisation and examines the key issues involved in her care. Particular attention is given to specific problems encountered on the acute care ward related to oxygen delivery, tracheostomy care, non-invasive ventilation and rehabilitation. The paper highlights the increased acuity of respiratory ward patients who require the use of substantial technological support to optimise their management. Nurses working in these wards need specialised knowledge, excellent patient communication ability and well-developed technical skills. The trend is to treat patients with respiratory failure, either chronic or acute, on wards rather than in critical care units' which has promoted the development of a specialised role in respiratory nursing.

Adult↗
PubMed2001

Antidepressant use in clinical practice: efficacy v. effectiveness.

BACKGROUND: Although the efficacy of antidepressants has been demonstrated in randomised, controlled clinical trials, it is how an antidepressant is used in clinical practice that determines its clinical effectiveness, or real-world efficacy. AIMS: To explore the frequency with which antidepressants are used at adequate dose and duration to obtain remission of symptoms and prevent relapse in clinical practice and discuss potential implications for clinical outcomes. METHOD: Studies of antidepressant prescribing were reviewed and comparisons made between antidepressant classes and individual compounds within those classes. RESULTS: Naturalistic studies show that patients who begin therapy on tricyclic antidepressants often receive sub-therapeutic doses for inadequate duration; conversely, patients who begin therapy on selective serotonin reuptake inhibitors more often receive an adequate dose of therapy for a longer duration. CONCLUSIONS; How antidepressants are used in clinical practice can determine the clinical outcomes that are achieved. Antidepressants that are more forgiving of sub-optimal prescribing and use patterns by providers and patients, respectively, may help to improve real-world efficacy.

Antidepressive Agents↗
PubMed2000

Brushing has made a sweeping change: use of the endoluminal FAS brush in haemodialysis central venous catheter management.

Common usage of central venous catheter (CVC) access for haemodialysis has presented the haemodialysis nurse with the challenge of maintaining CVCs as a viable form of access. The major complications seen with CVC use are obstruction and infection. A project was undertaken to identify the usefulness of the endoluminal fibrin analysis system (FAS) brush as an intervention in haemodialysis CVC management. The aims of the study were to identify: the reasons for brushing CVCs and the number of occasions brushing is indicated; how successful brushing is in unblocking and improving flow from CVCs, and the length of time the catheter remains patent following successful declotting. Seventeen patients were found suitable for CVC brushing and divided into two groups depending on the indication for brushing. In the group in which the catheter was brushed to restore flow, 73 per cent of brushings were successful, and in 50 per cent of those cases the CVC remained patent for 6 weeks. Sixty per cent of catheter brushings to improve flow were successful, and in 50 per cent of the CVCs flow was sustained over a 6-week period. Overall, the findings support the use of the endoluminal FAS brush for the applications trialled.

Catheterization, Central Venous↗
PubMed2000

A comparison of the awareness and utilisation of postoperative health services provided to women with breast cancer in public and private hospitals.

Nurses at a metropolitan Cancer Care Centre (CCC) noted that women who have had recent breast surgery for carcinoma had significantly different levels of knowledge and use of support services depending upon public or private hospitalisation. The public hospital participants were more aware of the range of available services (mean = 3.6) compared to women from the private sector (mean = 2.6). In addition, the public hospital participants were more likely to access a wider range of services post discharge (mean = 2.21) compared to the private hospital women (mean = 0.85). A significant difference was found between younger and older women's use of services.

Adult↗
PubMed2000

Antidepressant use patterns in clinical practices: comparisons among tricyclic antidepressants and selective serotonin reuptake inhibitors.

OBJECTIVE: Antidepressant use in clinical practice may differ from that in randomized controlled trials due to the complex interaction between patients, prescribers and the health-care system. METHOD: A review of studies using data from actual clinical practice has found consistent differences in the prescribing patterns of tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs). RESULTS: Patients who initiate therapy on SSRIs are more likely to complete a course of adequate dose and duration of antidepressant therapy than patients who initiate therapy on a TCA. Differences in prescribing patterns have also emerged among the most common SSRIs, fluoxetine, sertraline and paroxetine, that are also consistent over time, settings and countries. CONCLUSION: Given that the drugs studied are one constant across all the studies, the antidepressants' underlying pharmacological differences in tolerability and other properties may provide an explanation for differences in prescribing patterns.

Antidepressive Agents, Tricyclic↗
PubMed2000

Catheter brushing has made a sweeping difference to our clinical practice.

Our experience thus far has been very positive with a zero complication rate. This fact coupled with the benefits of minimizing delays in dialysis schedules, the 'speed' at which the procedure can be performed, and the cost-effectiveness of brushing results in our unit now choosing this technique as first line management for blocked catheters. From the perspective of the patient, there is little or no discomfort associated with the procedure. The simple principles of the brushing technique mean the procedure can be performed at the bedside by an accredited medical officer registrar or registered nurse. Explanation of the procedure and discussion about the benefits of endoluminal brushing versus catheter replacement, coupled with a zero complication rate, has gained the approval of patients. The endoluminal brushing procedure takes approximately 30 minutes to perform, compared with several hours the patient must wait to have a catheter replaced. This results in minimal delays in dialysis schedules and improved client satisfaction. Catheter occlusion and the inconvenience associated with catheter replacement was a very real problem for our HD unit. Our experience to date supports the use of endoluminal brushing as a cost-effective and timely means of restoring catheter patency.

Aged↗
PubMed1999

Natural history of pharmacotherapy of older depressed community residents. The MRC-ALPHA Study.

BACKGROUND: Depression in older people is common and has a high mortality, but effective treatments exist. AIMS: To describe drug prescribing in older community residents in relation to depression status. METHOD: The MRC-ALPHA community cohort aged 65 and over were interviewed using the Geriatric Mental State examination drug data collected at index interview and at two and four years. RESULTS: Antidepressants were used by 10.9% of the depressed population. Benzodiazepines were used frequently. Of the antidepressant users, 59.6% took low-dose antidepressants for two years, had a poor outcome and few drug changes. CONCLUSIONS: Trends of increasing antidepressant use have cost implications for primary care groups. Benzodiazepines may be mis-prescribed for treatment of depressive symptoms. Antidepressant users have poor outcome and follow-up.

Aged↗
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↗