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Biomedical subjects

J Kidd

Publications and source records attributed to J Kidd.

At least 19 recordsLinked to original sources
PubMed2006

Navigating uncharted water: research ethics and emotional engagement in human inquiry.

Sensitive research necessitates routine ethical practices of confidentiality, anonymity and worthiness. However, when co-constructing narratives with participants, the nurse researcher also faces unexplored ethical issues that arise out of the emotional intensity and professional responsibility inherent in the relationship. Such issues may be recognized and managed using clinical supervision in addition to academic supervision. Researcher vulnerability adds depth and complexity to human inquiry.

Adaptation, Psychological↗
PubMed2005

Blurring the boundaries: scenario-based simulation in a clinical setting.

CONTEXT: The ability to perform clinical procedures safely is a key skill for health care professionals. Performing such procedures on conscious patients is challenging and requires a combination of technical and communication skills. We have developed quasi-clinical scenarios, where inanimate models attached to simulated patients provide a convincing learning environment. Procedures are rated by expert observers and by the 'patient' and recorded for subsequent review. This study explores the potential of locating such scenarios within a real clinical setting, allowing participants to experience the challenges of the workplace while ensuring patient safety. An innovative portable digital recording device (the 'Virtual Chaperone') is evaluated for use in clinical settings. METHODS: A qualitative design (observation and interview studies) investigated volunteer medical students undertaking 2 procedure scenarios (insertion of urinary catheter and wound closure with sutures) within the accident unit of a large London hospital. All procedures were observed in real time and recorded digitally (using the Virtual Chaperone). A protocol was used for structured feedback. Observational and interview data was analysed using standard qualitative techniques. RESULTS: Seven sessions with 22 undergraduate medical students took place over 9 months within 1 centre. Data confirmed the feasibility of using a moveable, self-contained training scenario within an authentic clinical setting. Overall, the response from participants was positive. CONCLUSION: Scenario-based teaching within an authentic clinical environment is feasible and perceived by participants to be educationally useful. This approach blurs traditional boundaries between skills laboratory teaching and clinical practice and may offer considerable advantages in training for clinical procedures.

Clinical Competence↗
PubMed2004

Listen to the patient: quality of life of patients with recently diagnosed malignant cord compression in relation to their disability.

Quality of life (QOL) was determined using the shortened version of the Schedule for the Evaluation of Individual Quality of Life (SEIQoL-Dw), in 180 patients, shortly after a diagnosis of malignant cord compression. The median SEIQoL score was 66 (maximum 100). Twenty-five per cent of patients had a score >83. SEIQoL correlated with KPS (P<0.004) but the range of scores for each level of performance was very wide. Although there was an association between SEIQoL and ability to walk, the difference was small and not significant. SEIQoL was adversely affected by emotional distress as measured using HAD (P<0.01), although few patients were identified as being severely depressed. The findings are a reminder that QOL as determined by the patient may not coincide with health professionals' opinions.

Activities of Daily Living↗
PubMed2003

The use of handheld computers in scenario-based procedural assessments.

This paper describes the authors' experiences of using handheld computers within scenario-based formative assessments aimed at developing clinical procedural skills. Previous experiences of using paper forms in these assessments were problematic. Multiple paper forms were generated and data sets were sometimes incomplete. Forms adapted for use on handheld computers offer significant potential advantages over paper-based versions. These include streamlining the process of data collection, entry and retrieval, thereby reducing data loss and providing learners with immediate and cumulative feedback on their performance. All participants in this study found the Personal Digital Assistant (PDA) forms easy to use. Further adaptation, together with increased familiarity with PDA technology, will address users' feedback by providing more space for free text and a larger visual field. Technical expertise is required for the development and delivery of PDA-based forms, but their potential for use in formative and summative assessments is considerable.

Attitude of Health Personnel↗
PubMed2002

Don't wait for a sensory level--listen to the symptoms: a prospective audit of the delays in diagnosis of malignant cord compression.

AIM: To report details concerning symptoms (especially pain) preceding the development of malignant cord compression (MCC); delays between onset/reporting of symptoms and confirmed diagnosis of MCC; accuracy of investigations carried out. METHODS: A prospective observational study examined the diagnosis, management and outcome of 319 patients diagnosed with MCC at three Scottish cancer centres between January 1998-April 1999. The process was considered from the perspectives of the patient, the GP and the hospital doctor. RESULTS: At diagnosis, most patients (82%) were either unable to walk or only able to do so with help. Pain was reported by nearly all patients interviewed (94%) and had been present for approximately 3 months (median=90 days). It was severe in 84% of cases, with the distribution and characteristics of nerve root pain in 79%. The site of pain did not correspond to the site of compression. Where reported, weakness and/or sensory problems had been noticed by the patient for some time before diagnosis (median intervals 20 and 12 days, respectively). Most patients reported early symptoms to their General Practitioner (GP) and diagnosis was established, following referral and investigation, approximately 2 months (median=66 days) later. CONCLUSION: Patients who develop spinal metastases are at risk of irreversible spinal cord damage. Weakness and sensory abnormalities are reported late and identified even later, despite patients having reported pain for a considerable time. Patients with cancer who describe severe back or spinal nerve root pain need urgent assessment on the basis of their symptoms, as signs may occur too late. Plain films and bone scans requested for patients in this audit predicted accurately the level of compression in only 21% and 19% of cases, respectively. The only accurate investigation to establish the presence and site of a compressive lesion is magnetic resonance imaging (MRI). A referral guideline based on suspicious symptoms in addition to suspicious signs is suggested.

Aged↗
PubMed2000

Intussusception following the Ladd procedure.

HYPOTHESIS: The Ladd procedure for malrotation predisposes children to postoperative intussusception (POI). DESIGN: Retrospective case-control review. SETTING: University-affiliated tertiary care pediatric hospital. PATIENTS: Five of 159 patients undergoing the Ladd procedure between 1995 and 1998 developed POI. Predisposing factors were sought by comparison with age-matched controls who underwent the Ladd procedure during the same period. The entire Ladd group was compared with all 1717 patients undergoing any other laparotomy during the same period for incidence of POI. MAIN OUTCOME MEASURES: Differences in weight, percentile weight, age, length of nasogastric suction, time to oral intake, and length of stay between Ladd patients developing POI and age-matched controls from the Ladd group were compared using the Mann-Whitney U test. Incidence of POI after the Ladd procedure and "other laparotomy" was compared using chi2 analysis. RESULTS: In the Ladd group, there were 5 cases of POI (3.1%). There was 1 case of POI (0.05%) after all other laparotomies (P<.001). Symptoms developed at a mean +/- SD of 7.2 +/- 2.1 days. Upper gastrointestinal tract with small bowel follow-through showed partial bowel obstruction in 4 cases and was normal in 1 case. Reexploration took place at a mean +/- SD of 9.2 +/- 2.8 days. Children developing POI after undergoing the Ladd procedure were less likely to be small for their age (P= .03) than age-matched controls undergoing the Ladd procedure. CONCLUSIONS: The Ladd procedure predisposes children to POI. Aggressive investigation, including reexploration, should not be delayed if a child has symptoms of prolonged ileus within 2 weeks after undergoing a Ladd procedure.

Case-Control Studies↗
PubMed1996

Variation in measurement of ankle-brachial pressure index in routine clinical practice.

PURPOSE: The purpose of this study was to determine the variation in ankle-brachial pressure index (ABPI) measurements in routine clinical practice. METHODS: Analysis was done of preoperative and postoperative ABPIs in 130 limbs contralateral to those undergoing femoral bypass grafting in 123 patients over a 15-month period. RESULTS: The mean initial ABPI was 0.72 (range 0.22 to 1.10). The range of observed differences between the preoperative and postoperative ABPIs was from -0.33 to +0.25. The mean (+/-SD) difference between the first and second ABPIs was 0.00 (+/-0.11). The 95% confidence limits of the difference were -0.21 to 0.21. There was no trend for the size or direction of the difference in ABPI to vary according to the mean ABPI, brachial blood pressure, or time between tests. CONCLUSIONS: ABPI is routinely used as an objective measure of peripheral vascular disease. The variation observed in this study is comparable with values obtained in reproducibility studies and is greater than that accepted in clinical practice. The difference between an ABPI measurement and the actual ABPI and the difference between repeat single measurements are not the same and should be distinguished. Vascular laboratories should determine the accuracy of ABPI measurement on a local basis to guarantee and maintain quality assurance.

Aged↗
PubMed1995

Early outcome and intermediate follow-up of vascular stents in the femoral and popliteal arteries without long-term anticoagulation.

PURPOSE: The role of arterial stenting in the treatment of femoral and popliteal arterial disease is controversial and has been hampered by recommendations for patients to be given anticoagulants (oral warfarin) for several months or more. This study was undertaken to evaluate the immediate and midterm outcomes of vascular stents implanted percutaneously in the femoral and popliteal arteries, without long-term anticoagulation. METHODS: Over a 3-year period, 32 patients admitted to a vascular surgery service had arterial stents implanted in the femoral (n = 22) or popliteal (n = 10) artery for the following indications: recurrent stenosis after angioplasty (n = 13), suboptimal result after angioplasty of occluded (n = 12) or calcified stenotic arteries (n = 2), percutaneous transluminal angioplasty-induced thrombosis or dissection (n = 5). Access to the artery was gained by percutaneous insertion of a hemostatic sheath into the ipsilateral common femoral artery. Systemic heparin was given at the time of stent insertion, and patients were prescribed daily low-dose aspirin. RESULTS: Successful stent implantation was achieved in 31 of the 32 patients. Acute thrombosis (< 30 days) occurred in two patients. There was no incidence of false aneurysm formation, acute leg ischemia, or vessel perforation. All patients were monitored by Doppler scanning index and duplex scanning within 24 hours, and thereafter at 3- to 6-month intervals. The mean ankle-brachial systolic pressure index improved from 0.60 (before treatment) to 0.88 (3 to 6 months after stenting). Stent occlusion has occurred in six patients; two stents were successfully salvaged with urokinase infusion. In follow-up to date (range 3 to 33 months) the primary patency rate by life-table analysis was 75% at 18 months, whereas the secondary patency rate was 89% at the same interval. Restenosis (> 50% lumen diameter) was detected by duplex ultrasonography in seven of 25 patent stents (28%) at a mean interval of 9.5 months (range 4 to 15 months); of these, four patients remained clinically symptom-free despite the ultrasound findings. CONCLUSIONS: We conclude that vascular stents can be implanted into the femoropopliteal arteries with few complications and with acceptable early and intermediate patency rates, without the need for long-term anticoagulation. Restenosis is not prevented by stents, and the main value of stenting at this site appears to be in salvaging acute complications of percutaneous transluminal angioplasty, or to correct suboptimal results after recanalization of occluded arteries.

Aged↗
PubMed1994

Happy ever after.

Explore the source record for details and available documents.

Data Collection↗
PubMed1994

Air quality and respiratory functioning in children with pulmonary disorders.

This study was conducted to examine the relation between daily ambient air conditions, contaminants (eg, aeroallergens such as mold spores and pollen), and respiratory health indices of children with respiratory disorders (eg, asthma) residing in metropolitan Baton Rouge, Louisiana. Daily measures of peak expiratory flow rate (PEFR), respiratory symptoms, and other indices of health were monitored as subjects went about their normal daily activities. The results of this study suggest that high summer temperatures had the greatest impact on children's health status and activity level, with humidity and mold counts also contributing significantly to a decline in respiratory health indices.

Adolescent↗
PubMed1993

Teaching communication skills to clinical students.

Seven years' experience in teaching communication skills to first year clinical students at St Mary's Hospital School of Medicine is described. The first component consists of a day during the introductory clinical course; this is divided into a lecture and small seminar groups and involves behavioural scientists and clinicians from many departments. The second component uses simulated patients and video feedback and takes place in small groups later in the year. Participation of the students through active critical discussion, role play, and interactive video feedback are important aspects in the success of the course. The methods have been refined through evaluation by students and tutors. This article aims to allow others, already running or considering such a course, to develop effective courses within the practical constraints of their own institutions.

Clinical Competence↗
PubMed1993

Evolution of endothermy in fish: mapping physiological traits on a molecular phylogeny.

Mackerels, tunas, and billfishes (suborder Scombroidei and Teleostei) provide an ideal taxonomic context in which to examine the evolution of endothermy. Multiple origins and diverse strategies for endothermy exist among these fish. Here a molecular phylogeny of the Scombroidei has been determined by direct sequencing of a portion of the mitochondrial cytochrome b gene. The distribution of endothermic species within this proposed genealogy indicates that the ability to warm the brain and retina arose independently in three lineages, each time in association with a movement into colder water. This suggests that the evolution of cranial endothermy in fish was selected in order to permit thermal niche expansion and not selected for increased aerobic capacity.

Animals↗
PubMed1993

Is routine AFP screening in pregnancy reassuring?

The purpose of the study is to examine the impact of a negative result on a routine prenatal screening test, maternal serum alpha-fetoprotein screening for spina bifida and Down's syndrome. Three-hundred and nine women had the test and 30 did not. Twenty-one of the 309 did not think that they had been tested, and seven women who did not have the test thought that they had been tested. There were no significant differences between these four groups in anxiety, certainty about the baby's health or worry about the baby's health. These results suggest that the receipt of a negative result on this screening test does not provide reassurance. There are several possible explanations for this finding: the test is reassuring, but only for a small number of those undergoing the test; the test is reassuring but the study method was inappropriate and hence failed to detect it; the test is not reassuring because of a lack of knowledge about the meaning of a negative result or, the way in which results of testing are conveyed. The latter two explanations suggest that the potentially reassuring effects of such a result may be realised with more effective communication about test results.

Adult↗
PubMed1993

Anxiety, knowledge and satisfaction in women receiving false positive results on routine prenatal screening: a randomized controlled trial.

The majority of women receiving an abnormal result on routine prenatal screening subsequently give birth to unaffected children. Previous studies have documented high levels of anxiety in women receiving such false positive results. In an attempt to reduce this anxiety, two methods of preparing women for undergoing such testing were compared: provision of detailed written information about maternal-serum alpha-fetoprotein testing; and anxiety management training. Eligible women were randomly allocated to one of five groups. Eighty-five women subsequently received false positive results on routine alpha-fetoprotein testing. There was some evidence that completing the study questionnaires had an anxiety-reducing effect. In contrast with the results of previous studies, there was no evidence that receipt of an abnormal alpha-fetoprotein result resulted in raised anxiety. Neither of the interventions, alone or in combination, had an effect upon anxiety following an abnormal alpha-fetoprotein result. Receipt of detailed written information however, led to women having more knowledge and being more satisfied with the amount of information that they had. One in three of the class groups reported that the classes had influenced the way they had dealt with worries. Although the interventions did not reduce anxiety in this study, there are other reasons for considering their incorporation into routine clinical practice.

Anxiety↗