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Biomedical subjects

M Cooke

Publications and source records attributed to M Cooke.

At least 37 records · Page 2Linked to original sources
PubMed1998

Informal caregivers and the intention to hasten AIDS-related death.

OBJECTIVES: To determine the extent to which homosexual men dying of the acquired immunodeficiency syndrome (AIDS) receive medication intended to hasten death. To assess the impact on caregivers of administering medications intended to hasten death. METHODS: In a prospective study of caregiving partners of men with AIDS (n = 140), characteristics of the ill partner, the caregiver, and the relationship were assessed at baseline and 1 month before the ill partner's death. Three months after the death, caregivers were asked if they had increased their partner's narcotic and/or sedative-hypnotic medication dose and if so, what had been the objective of the increase, and their comfort with their medication decisions. RESULTS: Of 140 ill partners who died of AIDS, 17 (12.1%) received an increase in the use of medications immediately before death intended to hasten death. Diagnoses and care needs of ill partners who received increases in the use of medications to hasten death did not differ from those of ill partners receiving medication for symptoms. Fourteen increases (10%) in use of medications were administered by caregivers. These caregivers did not differ from those administering medication for symptom control in level of distress, caregiving burden, relationship characteristics, or comfort with the medication decision, but they reported more social support and positive meaning in caregiving. CONCLUSION: The decision to hasten death is not a rare event in this group of men. There is no evidence that it is the result of caregiver distress, poor relationship quality, or intolerable caregiving burden; and it does not cause excessive discomfort in the surviving partner. This study, although small, has implications for the policy debate on assisted suicide.

Acquired Immunodeficiency Syndrome↗
PubMed1998

The nature of the problem: the intentional design of problems to facilitate different levels of student learning.

This paper explores the deliberate design of 'problem' situations within a 3-year problem-based nursing degree conducted at Griffith University, Nathan, Queensland, Australia. It examines problem situations within the first and third years of the course to illustrate the issues involved in designing material that enables students to achieve the curriculum aims. Although the problem situations are designed from the same health care setting, the discussion highlights how concepts and issues can be addressed in different ways depending on the desired student outcomes. The paper outlines and examines the nature of student learning and the clinical reasoning process used by students in making decisions that closely mirror those made as registered nurses in order to facilitate the achievement of clients' health goals.

Curriculum↗
PubMed1998

Primary care groups will have to be good at this, and that and the other.

Functions of primary care groups (PCG) should be considered ahead of structures and those forming PCGs need to see the links between the key health and social policy initiatives. Early influence by PCGs will shape the design and local implementation of health action zones, health improvement programmes and performance frameworks. The Green Paper "Our Healthier Nation" and its successor are central to the emerging role of PCGs. Partnership work between GPs, practice staff, trusts, local authorities and health authorities needs emphasis. Recognition of what people and existing organisations can contribute needs to be given. Leadership themes of good primary care operations, health development and clinical leadership or their equivalents need time and space to emerge.

Family Practice↗
PubMed1997

Becoming a registered nurse.

This paper describes research carried out with clinical agencies and former students to ascertain the effectiveness of curriculum design within the third year of a problem-based Bachelor of Nursing programme. It shows that where holistic care, time management, prioritization of care, working as a team member, and sophisticated clinical reasoning were introduced as deliberate strategies in students' learning, the transition to the workplace was more successful.

Clinical Competence↗
PubMed1996

An outbreak of Salmonella typhimurium DT104 food poisoning associated with eating beef.

An outbreak of Salmonella typhimurium DT104 infection in Shropshire in May 1995 was identified when four isolates were noted to be from members or supporters of a local football team that had held several social functions in the same week. The subsequent investigation identified 16 people with gastrointestinal symptoms and 12 with microbiologically confirmed infection. The outbreak was complex, associated with several social functions on different days, but infection was associated with eating beef at a public house. A number of errors were detected in the cooking, storage, and handling of the implicated food. The investigation identified beef as the vehicle of infection in this outbreak but was unable to show whether it was the original source of infection or whether cross or manual contamination occurred in the kitchen.

Animals↗
PubMed1996

Postbereavement depressive mood and its prebereavement predictors in HIV+ and HIV- gay men.

Prebereavement predictors of the course of postbereavement depressive mood were examined in 110 gay men who were their partner's caregiver until the partner's death of AIDS. In all, 37 HIV+ and 73 HIV- bereaved caregiving partners were assessed bimonthly throughout a 10-month period beginning 3 months before and ending 7 months after the partner's death. Throughout the 10 months, mean Centers for Epidemiology Scale-Depression (CES-D) scores on depressive mood were above the cutoff for being at risk for major depression. CES-D scores decreased for 63% bereaved caregivers over the 7 postbereavement months, and 37% showed little change from high CES-D scores or increasing CES-D scores. High prebereavement CES-D scores and finding positive meaning in caregiving predicted diminishing depressive mood; HIV+ serostatus, longer relationships, hassles, and use of distancing and self-blame to cope predicted unrelieved depressive mood.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Evaluation of a cognitive-behavioural intervention for pregnant injecting drug users at risk of HIV infection.

Pregnant injecting drug users were randomly assigned to: (i) individually receive a six-session cognitive-behavioural intervention in addition to their usual methadone maintenance treatment (intervention condition (I) (n = 40)); or (ii) their usual methadone maintenance treatment only (control condition (C) (n = 40)). There was no change in drug use per se in either group after the intervention. However, at 9-month follow-up the I group had significantly reduced some HIV risk-taking behaviours (in particular injecting risk behaviours). The I group reduced the needle risk associated both with "typical" use (drug use in the month before interview) and "binge" use (drug use in the month nominated as the heaviest month of drug use in the previous 6 months). The intervention had no effect on sexual risk behaviours. The finding of reduced injecting risk behaviour following the six-session intervention suggests that such an intervention may be of benefit for individuals persisting with injecting risk behaviours despite methadone maintenance treatment and the availability of sterile injection equipment.

Adult↗
PubMed1996

Nursing students' perceptions of difficult or challenging clinical situations.

This study examined students' perceptions of difficult or challenging clinical situations and how facilitators assisted students in relation to these specific situations. Responses to open-ended questions from first-year nursing students before and after a series of hospital and community nursing practice placements were analysed. The findings suggest that students do find certain clinical situations difficult or challenging and that facilitators can greatly assist students to effectively deal with these through specific teaching strategies.

Attitude of Health Personnel↗
PubMed1996

Physician responses to a hospital policy allowing them to not offer cardiopulmonary resuscitation.

OBJECTIVE: To determine whether physicians followed a hospital policy permitting them to not offer cardiopulmonary resuscitation (CPR) to patients considered unlikely to benefit from this therapy. DESIGN: Prospective series. SETTING: San Francisco General Hospital, a university-affiliated public hospital. PATIENTS: Attending physicians were interviewed about patients admitted over a period of 5 consecutive months for whom do-not resuscitate (DNR) orders were written. Only the first patient for whom each physician wrote a DNR order was included. MAIN OUTCOME MEASURES: Responses of physicians to questions regarding their initiation of DNR orders for these patients. RESULTS: Sixty-nine physicians responded to questions about DNR orders written for 69 patients. Fifty-seven of these physicians said that they were aware of the hospital policy, and 49 of the 57 physicians said that they generally agreed with it. Thirty-three physicians felt that CPR should be offered only to patients likely to benefit from it. In contrast, 36 physicians said that CPR should be offered to all patients, regardless of benefit. CPR was offered to 41 patients and 15 surrogates; 27 of these patients were considered to be unlikely to benefit from CPR. CONCLUSION: Despite a policy that allows them to do otherwise, physicians usually offered CPR to patients, regardless of benefit. Most physicians believed that CPR should be offered to all patients. These findings suggest that policies such as that of San Francisco General Hospital may not be compelling because physicians hold attitudes that are inconsistent with the policies.

Attitude of Health Personnel↗
PubMed1996

Spinal boards.

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Accidents, Traffic↗