Biomedical subjects

Jill Cockburn

Publications and source records attributed to Jill Cockburn.

28 records · Page 2Linked to original sources

PubMed2003

Are the components of the Asthma Management Plan important in managing childhood asthma? A survey of general practitioners.

AIM: To gauge the importance and relevance placed by general practitioners on components of the National Asthma Campaign's 'Six step' Asthma Management Plan for childhood asthma. METHOD: A cross sectional postal survey of a national randomised sample of 824 GPs. RESULTS: Each component was considered to be 'quite' or 'very' important by at least 70% of respondents. All 11 components were rated to be either 'quite' or 'very' important by 44%, and 91% of respondents considered eight or more of the components to be 'quite' or 'very' important. Two characteristics were consistently associated with the rating of importance: gender, (women GPs generally showing higher ratings), and reported frequency of use of the Asthma Management Plan (frequent users rate importance more frequently). CONCLUSION: There were high levels of endorsement of the Asthma Management Plan for children with asthma.

Adolescent↗

PubMed2002

Promoting urinary continence in women after delivery: randomised controlled trial.

OBJECTIVES: To test the effectiveness of a physiotherapist delivered intervention designed to prevent urinary incontinence among women three months after giving birth. DESIGN: Prospective randomised controlled trial with women randomised to receive the intervention (which entailed training in pelvic floor exercises and incorporated strategies to improve adherence) or usual postpartum care. SETTING: Postpartum wards of three tertiary teaching hospitals in the Hunter region, New South Wales, Australia. PARTICIPANTS: Women who had forceps or ventouse deliveries or whose babies had a high birth weight (> or =4000 g), or both-676 (348 in the intervention group and 328 in the usual care group) provided endpoint data at three months. MAIN OUTCOME MEASURES: Urinary incontinence at three months measured as a dichotomous variable. The severity of incontinence was also measured. Self report of the frequency of performance of pelvic floor exercises was recorded. RESULTS: At three months after delivery, the prevalence of incontinence in the intervention group was 31.0% (108 women) and in the usual care group 38.4% (125 women); difference 7.4% (95% confidence interval 0.2% to 14.6%, P=0.044). At follow up significantly fewer women with incontinence were classified as severe in the intervention group (10.1%) v (17.0%), difference 7.0%, 1.6% to 11.8%). The proportions of women reporting doing pelvic floor exercises at adequate levels was 84% (80% to 88%) for the intervention group and 58% (52% to 63%) for the usual care group (P=0.001). CONCLUSIONS: The intervention promoting urinary continence reduced the prevalence of urinary incontinence after giving birth, particularly its severity, and promoted the performance of pelvic floor exercises at adequate levels; both continence and adherence to the programme were measured at three months after delivery in women who had forceps or ventouse deliveries or babies weighing 4000 g or more.

Adult↗

PubMed2002

Estimating the contribution of individual risk factors to disease in a person with more than one risk factor.

Various measures have been proposed to express the excess risk of an outcome attributable to one particular risk factor, such as attributable risk and risk fraction. However, there is sometimes a need, both in epidemiological studies and in awarding compensation in legal cases, to simultaneously consider the contribution of several risk factors to a disease outcome, when a biological model is not available. We propose a method that allocates the proportional contribution of several risk factors to a disease outcome, based on the weighted contribution of the risk fraction for each risk factor. We demonstrate the use of this method using figures for renal cell carcinoma, and discuss the caveats in using this method for epidemiologic studies, and in awarding compensation in legal cases.

Asbestos↗

PubMed2002

Synergizing acute care and palliative care to optimise nursing care in end-stage cardiorespiratory disease.

Advances in the practice of medicine and nursing science have increased survival for patients with chronic cardiorespiratory disease. Parallel to this positive outcome is a societal expectation of longevity and cure of disease. Chronic disease and the inevitability of death creates a dilemma, more than ever before, for the health care professional, who is committed to the delivery of quality care to patients and their families. The appropriate time for broaching the issue of dying and determining when palliative care is required is problematic. Dilemmas occur with a perceived dissonance between acute and palliative care and difficulties in determining prognosis. Palliative care must be integrated within the health care continuum, rather than being a discrete entity at the end of life, in order to achieve optimal patient outcomes. Anecdotally, acute and critical care nurses experience frustration from the tensions that arise between acute and palliative care philosophies. Many clinicians are concerned that patients are denied a good death and yet the moment when care should be oriented toward palliation rather than aggressive management is usually unclear. Clearly this has implications for the type and quality of care that patients receive. This paper provides a review of the extant literature and identifies issues in the end of life care for patients with chronic cardiorespiratory diseases within acute and critical care environments. Issues for refinement of acute and critical care nursing practice and research priorities are identified to create a synergy between these philosophical perspectives.

Cooperative Behavior↗

PubMed2002

Screening for bowel cancer among NSW adults with varying levels of risk: a community survey.

OBJECTIVE: To estimate the extent and modality of screening for colorectal cancer in NSW among community-dwelling adults aged over 40 with varying degrees of familial risk. DESIGN: Cross-sectional telephone survey with participants randomly selected from the electronic NSW telephone directory. MAIN RESULTS: 5.7% of people at average risk aged 40-49 report having had at least one faecal occult blood test (FOBT) in the previous five years, compared with 18.4% of those at average risk aged 50 and over. Of those at above-average risk (by age and familial risk), 7.9% reported that they had had an FOBT in the previous five years. Around 5% of respondents aged 40-49 and 10% of those aged 50+ reported having had a colonoscopy/sigmoidoscopy for screening within the previous five years, compared with 30% of those at above-average risk. People with medical insurance were more likely to have undergone a screening test (either FOBT or sigmoidoscopy/colonoscopy), than those without insurance (PR = 1.30; 95% CI 1.02-1.67). Compared with those employed full time, those who were retired (PR = 1.45 95% CI 1.01-2.09) and those who reported home duties (PR = 1.54 95% CI 1.01-2.36) were slightly, but significantly more likely to report having had a test. As perception of personal risk for colorectal cancer increased, so did the likelihood of having had a screening test within the previous five years (PR = 1.19; 95% CI 1.05-1.35). CONCLUSION: We have reported important baseline data with which to compare the progress of both pilot screening programs and more widespread implementation of colorectal screening in Australia. In particular, we have highlighted the need for greater participation in screening for those at increased familial risk.

Adult↗

PubMed1999

The development of a physiotherapy continence promotion program using a customer focus.

Health promotion programs provide information, education for health and opportunity for the development of the skills that people need to make healthy choices. The current climate of health care practice also directs its focus to the needs and wants of the health care consumers. This entails active input from the target group. The present study used focus groups in an attempt to ensure input from women in early postpartum into the development of a postpartum continence promotion program. The focus groups revealed anomalies in women's perceived susceptibility to, and knowledge about, urinary incontinence and pelvic floor exercises, while highlighting other areas of need. Focus groups proved an invaluable tool in the development of a more effective physiotherapy continence promotion program.

Journal Article↗

PubMedDate not supplied

Integrated, collaborative palliative care in heart failure: the St. George Heart Failure Service experience 1999-2002.

BACKGROUND: Chronic heart failure (HF) is the only heart condition increasing in prevalence and is primarily a condition of aging. This condition has outcomes worse than many cancers; however, patients are often denied the benefits of palliative care with its important emphasis on symptom management, spirituality, and emotional health and focus on family issues. AIM: To describe the development of a model of an integrated, consultative, palliative care approach within a comprehensive HF community-focussed disease management program. METHOD: A collaborative model was developed following a systematic needs assessment and documentation of local resources. Principles underpinning this model were based upon fostering of communication, consultancy, and skill development. Within this model a health care system, based upon universal coverage, supported co-management of patients and their families. The place of death, level of social support available at home, and degree of palliative care involvement was documented in 121 consecutive deaths from 1999-2002. FINDINGS: Following a period of skill sharing and program development, only 8.3% of HF patients in the collaborative program required specialized palliative care intervention for complex symptom management, carer support, and issues related to spirituality. Twenty percent of this cohort died in nursing homes underscoring the importance of supporting our nursing colleagues in this setting. CONCLUSIONS: In spite of well-documented difficulties in determining prognosis, it is the St George experience that key principles of a palliative care strategy can be implemented in a HF disease management program with support and consultancy from expert palliative care services.

Community Health Services↗

PubMedDate not supplied

Patient-centered needs assessment: rationale for a psychometric measure for assessing needs in heart failure.

Determining an individual's unique perspective of an illness experience remains a challenge for clinicians, administrators, and researchers. A range of concepts and psychometric measures have been developed and evaluated to capture this information. These include patient satisfaction, quality of life, and utility measures. Needs assessment as a tool for evaluating perceptions of health status and determining patient satisfaction and treatment plans has been explored in oncology. Studies have demonstrated that a high proportion of patients have unmet needs in relation to activities of daily living, information sources, and comfort. Heart failure (HF), a condition with significant individual and societal burden, mirrors the illness of experience of cancer, as individuals process issues related to prognosis, treatment regimens, and decreased functional status. A needs-based assessment of health status, expectations, and perceptions is patient-centered and has the capacity to not only evaluate current health status but also plan and project care plans. Needs assessment is a dynamic construct rather than a point in time consistent with other assessment modalities, such as quality of life. Multidimensional needs assessment allows for planning and projection of needs, not only on an individual but also a population basis. Implicit in the exploration of needs is an expectation of level of care to be provided, from both the provider and recipient of care. In many instances a misalignment may exist between services and resources available to the individual. This article seeks to provide a theoretical justification for the development of a needs assessment instrument for patients with HF and to discuss the rationale of this method of assessment to create better alignment and resources with patients needs and expectations.

Colonic Neoplasms↗

PubMedDate not supplied

Skin penetration operators' knowledge and attitudes towards infection control.

OBJECTIVES: To assess the knowledge and attitudes of owners/managers of commercial skin-penetration premises regarding infection control. METHODS: A telephone survey was conducted with a randomly selected sample of 874 owners/managers. RESULTS: Participants appeared to lack knowledge of essential infection-control practices. Less than 39% correctly identified recommended disinfection procedures, and between 12% to 67% were not aware of inappropriate sterlization procedures. Almost all participants accepted the need for guidelines. Half acknowledged a need to improve their infection-control compliance, and most accepted having their premises regularly checked by the councils. CONCLUSIONS: There is a considerable opportunity to increase infection-control compliance among skin-penetration operators.

Adult↗

PubMedDate not supplied

Delay in seeking advice for symptoms that potentially indicate bowel cancer.

OBJECTIVES: To document knowledge, behavior and experiences of adults regarding potential signs and symptoms of bowel cancer. METHODS: Telephone interviews with 1332 randomly selected adults, using similar questions to a survey conducted in 1988. RESULTS: Twenty three percent (n=306) of respondents reported that they had experienced blood in bowel motions and about one third of these reported that they did not seek medical advice at all. CONCLUSIONS: As there has been no change in help seeking for potential symptoms of bowel cancer from similar studies conducted 15 years ago, there are concerns for encouraging behaviors that will result in the early detection of colorectal cancer.

Adult↗