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Biomedical subjects

M L Jones

Publications and source records attributed to M L Jones.

At least 37 records · Page 2Linked to original sources
PubMed2000

Implementation and outcomes of a balanced scorecard model in women's services in an academic health care institution.

In the current, chaotic health care climate an important success determinant for health care administrators and clinicians is the support of timely, collaborative decisions for delivery of patient care. The purpose of this article is to describe implementation and outcomes of the application of the Balanced Scorecard (BSC) model, a strategic management system, for a Women's Services Clinical Business Unit (CBU) in an academic health care institution, a complex adaptive system. Emphasis is focused on crucial process and outcome indicators that demonstrate how the work of all team members makes a difference at the point of clinical services across the continuum. Finally, implications for leadership development are revealed from the principles underlying complexity science.

Academic Medical Centers↗
PubMed2000

Chlamydial development is adversely affected by minor changes in amino acid supply, blood plasma amino acid levels, and glucose deprivation.

This study has demonstrated the extreme sensitivity of Chlamydia trachomatis growing in McCoy cells to small changes in external amino acid supply. In the absence of cycloheximide, a decrease in the amino acid concentration of medium to 75% of control values was sufficient to induce the growth of enlarged chlamydial forms of reduced infectivity. Morphology became more distorted and the yield of infectious particles from inclusions declined as medium amino acid levels were further reduced. These events correlated with a general decline in intracellular amino acids, as measured by high-performance liquid chromatography, suggesting that chlamydiae require a minimum concentration of each amino acid for normal development. Cycloheximide enhanced the production of normal organisms and increased infectivity yield in media, suggesting that the drug increased the available pool of amino acids. This was supported by intracellular amino acid analyses. Aberrant forms with reduced infectivity were also induced during supply of infected cell cultures with medium containing blood plasma amino acid concentrations, supporting the proposal that nutrient levels in vivo could promote abnormal chlamydial development. Markedly abnormal forms were also observed during glucose deprivation, providing further evidence that aberrant development is a general stress-related response.

Amino Acids↗
PubMed2000

The influence of bracket base design on the strength of the bracket-cement interface.

The objectives of the study were to isolate the bracket-cement interface, and to determine the influence of bracket base morphology and orthodontic bonding agent chosen on strength of adhesion. The bracket bases evaluated included 60, 80, and 100 single mesh bases, a double mesh base, and the Dynalock, and Mini Twin bases. The strength of interface provided by each of these bases with Concise, Transbond, Right On, and non-encapsulated Fuji Ortho LC cements, was measured in tension and recorded in Mega Pascals. The single-mesh bases performed well with either Concise or Right On (11*88-22*72 MPa) and, other than the 80-mesh bracket, relatively poorly with Transbond (2*18-5*15 MPa). With Fuji Ortho LC, the single mesh bases performed well (6*05-12*19 MPa). The double mesh base performed well with Right On (13*75 MPa), and reasonably well with Concise, Transbond, and Fuji Ortho LC (6*00-9*20 MPa). The Dynalock and Mini Twin Bases performed fairly well with all cements (8*87-17*16 MPa). It was concluded that the orthodontic bonding agent selected would appear to largely determine the bond strength achieved with a particular bracket base design. A definite trend was difficult to identify in this study, and it appeared that certain combinations of bracket base and bonding agent performed optimally. Particular base designs may allow improved adhesive penetration or improved penetration of curing light. Alternatively, the dimension and distribution of resin/cement tags prescribed by one base could promote a stress distribution that is better resisted by a particular adhesive.

Acrylic Resins↗
PubMed2000

Numerical investigation of fixed orthodontic brackets.

This paper presents the results of investigations into the mechanical behaviour of fixed orthodontic brackets. Special attention has been paid to the detailed modelling of the interface between the bracket base and an adhesive by which attachment is made to the tooth surface. Properties of this interface were taken as design parameters with the aim of investigating their influence on the stress field induced during bracket removal at the end of the treatment. Stress-strain analysis was performed using a finite element program developed in-house.

Dental Cements↗
PubMed2000

Do new roles contribute to job satisfaction and retention of staff in nursing and professions allied to medicine?

BACKGROUND: Studies have suggested that job dissatisfaction is a major factor influencing nurses' and occupational therapists' intention to leave their profession. It has also been related to turnover of qualified nurses. However, literature relating to these factors among nurses and professions allied to medicine in innovative roles is scarce. AIMS: This paper considers the views of 452 nurses and 162 professionals allied to medicine (PAMs) in innovative roles, on job satisfaction, career development, intention to leave the profession and factors seen as hindering and enhancing effective working. METHODS: A self-completion questionnaire was developed as part of a larger study exploring new roles in practice (The ENRiP Study). FINDINGS: Overall there was a high level of job satisfaction in both groups (nurses and PAMs). Job satisfaction was significantly related to feeling integrated within the post-holder's own professional group and with immediate colleagues, feeling that the role had improved their career prospects, feeling adequately prepared and trained for the role, and working to protocol. Sixty-eight percent (n = 415) of respondents felt the role had enhanced their career prospects but over a quarter of respondents (n = 163; 27%) said they would leave their profession if they could. Low job satisfaction was significantly related to intention to leave the profession. CONCLUSIONS: The vast majority of post-holders in innovative roles felt that the role provided them with a sense of job satisfaction. However, it is essential that the post-holders feel adequately prepared to carry out the role and that the boundaries of their practice are well defined. Career progression and professional integration both being associated with job satisfaction.

Adult↗
PubMed1999

Protection of calves against cryptosporidiosis with immune bovine colostrum induced by a Cryptosporidium parvum recombinant protein.

The purpose of the study was to determine if immunization with a recombinant protein (rC7) of Cryptosporidium parvum would induce immune bovine colostrum that protected calves against cryptosporidiosis following oral challenge with C. parvum oocysts. Late gestation Holstein cows with low titers of antibody to the p23 antigen of C. parvum were immunized three times with 300 microg affinity purified rC7 C. parvum recombinant protein (immune cows), or left nonimmunized (control cows). Colostrum was obtained from each cow in both groups and partitioned into identical aliquots of pooled immune colostrum or pooled control colostrum. Twelve calves obtained at birth received either immune or control colostrum within the first 2 h, and again at 12 and 24 h of age. Each calf was challenged orally with 10(7) C. parvum oocysts at 12 h of age and monitored for signs of cryptosporidiosis. All six calves administered pooled control colostrum developed severe diarrhea (mean total fecal volume = 8447+/-5600 ml) and shed an average of 1.87+/-1.66 x 10(12) C. parvum oocysts. None of the six calves administered pooled immune colostrum developed diarrhea (mean total fecal volume = 740+/-750 ml, p < 0.05), and shed significantly fewer oocysts (3.05+/-2.26 x 10(9), p < 0.05). The absence of diarrhea and 2.79 log10 (99.8%) reduction in oocyst excretion indicates that immune bovine colostrum induced by immunization with C. parvum recombinant protein rC7 provided substantial protection against cryptosporidiosis in neonatal calves.

Animals↗
PubMed1999

Leukocyte subsets and neutrophil function after short-term spaceflight.

Changes in leukocyte subpopulations and function after spaceflight have been observed but the mechanisms underlying these changes are not well defined. This study investigated the effects of short-term spaceflight (8-15 days) on circulating leukocyte subsets, stress hormones, immunoglobulin levels, and neutrophil function. At landing, a 1.5-fold increase in neutrophils was observed compared with preflight values; lymphocytes were slightly decreased, whereas the results were variable for monocytes. No significant changes were observed in plasma levels of immunoglobulins, cortisol, or adrenocorticotropic hormone. In contrast, urinary epinephrine, norepinephrine, and cortisol were significantly elevated at landing. Band neutrophils were observed in 9 of 16 astronauts. Neutrophil chemotactic assays showed a 10-fold decrease in the optimal dose response after landing. Neutrophil adhesion to endothelial cells was increased both before and after spaceflight. At landing, the expression of MAC-1 was significantly decreased while L-selectin was significantly increased. These functional alterations may be of clinical significance on long-duration space missions.

Adrenocorticotropic Hormone↗
PubMed1999

The cost and value of pre-registration clinical placements for Project 2000 students.

The research outlined in this article was commissioned by the Sheffield and North Trent College of Nursing and Midwifery to explore the cost implications of pre-registration clinical placements in the context of Project 2000. The authors outline the methodology and findings of an exercise designed to collect relevant cost information which was not readily available. On the basis of these findings, they suggest that: at 1995/1996 pay and prices, clinical placements cost the education provider approximately pound 890 per student per annum; in terms of real resources, the value to service providers of the service contribution made by second- and third-year nursing and midwifery students on ward-based placements outweighs the value of the time spent by qualified staff on their supervision and education. Once the funding assumptions underlying the introduction of Project 2000 have been taken into account, second- and third-year nursing and midwifery students benefit the service provider by on average pound 3.46 for every hour they spend in an unrostered ward-based placement. The service contribution made by students in community-based clinical placements cannot free staff time in the same way as on the wards and, because qualified staff in these areas are generally more highly graded, the value of the time they spend on the supervision and education of students on placement is higher than in ward-based placements. Second- and third-year students therefore appear to cost the service provider on average pound 0.48 for each hour they spend in a community-based placement. It was not possible to determine whether this cost translates into a reduction in patient contacts.

Cost-Benefit Analysis↗
PubMed1999

Application of a subjective health and safety rating system to Iowa farm operations.

A rapid, subjective health and safety assessment tool was developed and applied to 121 farm operations visited during a cross-sectional, on-farm industrial hygiene (IH) study of the Iowa Farm Family Health and Hazard Surveillance Project (IFFHHSP). The study utilized a single field investigator who conducted visits of farm operations from August 1995 to July 1996. The farm operations visited were randomly selected from a stratified, two-stage cluster sample of Iowa farm operations. The tool developed and applied to each farm operation--the Site Rank System--was based on the average of scores assigned to four different farm characteristics, which we believed would predict the health and safety status of the farm operations. Two of these characteristics were based on an assessment of each farm's operator (operator attitude and operator practices) and the other two were based on weighted scores assigned to physical components of the farm operation (status of facilities and status of equipment). The Site Rank System was found to have been assigned consistently, but an analysis comparing the Site Rank System scores to initial in-depth medical and environmental data gathered from the visited farm operations via self-reported questionnaires showed little correlation with outcomes. However, self-reported injuries (11 total) which occurred to the principal farm operators of the farm operations visited during the on-farm IH study phase (August 1995 to July 1996) correlated with low Site Rank System scores.

Agriculture↗
PubMed1999

An evaluation of the changes in maxillary pulpal blood flow associated with orthognathic surgery.

The objective of this study was to evaluate the use of the Laser Döppler Flowmeter (LDF) in the measurement of pulpal blood flow following orthognathic surgery and to conduct an initial study of the effects of a Le Fort I osteotomy on the pulpal blood flow of the maxillary central incisors. The design consisted of a preliminary prospective controlled consecutive clinical trial undertaken at the Orthodontic Clinic, University Dental Hospital NHS Trust, Wales, 1994. The study group consisted of 15 consecutive patients who were to receive a standard advancement Le Fort I osteotomy. Seven patients who were to undergo a mandibular advancement only acted as a control. A further 20 separate patients participated in a study for the assessment of measurement error. The blood flow in relative perfusion unit v. time, was measured using a Laser Döppler Flowmeter. Measurement error for flowmeter recordings with hand-held application and custom-made splint support showed no consistent difference or significant random variation between the two methods for holding the probe against the teeth (pooled S.D. of reproducibility 1/1 = 1.91/1.39 for custom splint location as opposed to 0.96/1.07 for hand-held/fixed bracket location). For the surgical patients under investigation no significant differences for maxillary pulpal blood flow were found in the control group (mandibular osteotomy) over time. However, in the maxillary osteotomy patients there was a tendency for an initial rise in the maxillary perfusion post-surgery as measured at the central incisor pulps, followed by an overall reduction at 6 months. As an example, the mean value for the upper right central showed a significant increase in blood flow during the immediate post-operative period (P < 0.05), but at 6 months after surgery demonstrated a statistically significant overall reduction in comparison with the presurgical reading (P < 0.001). The laser Döppler flowmeter is not an easy instrument to use in the clinical assessment of pulpal blood flow. However, it would appear from these longitudinal series of readings, taken over a 6-month period on 15 patients, that the maxillary perfusion recorded at the central incisor pulps may be permanently affected in many Le Fort I osteotomy patients. For patients that already have a prejudiced blood supply this could lead to devitalization and discoloration of incisors. It is not known if this affect on the perfusion of the pulp continues beyond 6 months post-surgery.

Blood Flow Velocity↗
PubMed1999

Implementation of a clinical pathway system in maternal newborn care: a comprehensive documentation system for outcomes management.

This article describes the design, implementation, and evaluation of an interdisciplinary clinical pathway system for maternal newborn care in a perinatal regional referral institution. Core issues in the design of this system are addressed to promote outcomes management and ongoing performance improvement. A discussion of the implementation follows, illustrating the lessons learned, changes made, and associated evaluation. This clinical pathway system has improved communication and collaboration among all disciplines, enhanced the discharge coordination process, and established protocols available to all members of the health care team.

Adult↗
PubMed1999

A clinical pathway system for the neonatal intensive care nursery.

Health care reform, managed care, and the current outcomes movement have generated a rapid acceleration toward the development and implementation of clinical pathways in the field of neonatology. This article describes the design, implementation, and evaluation of an interdisciplinary clinical pathway system for a neonatal intensive care nursery. This neonatal clinical pathway is a clinical tool that delineates practice guidelines for each discipline that provides care to a specific infant population. It has reduced variation in clinical process and thereby has been shown to improve the quality of infant care. When practice guidelines and documentation are linked to health and economic outcomes, they begin to significantly impact health care costs.

Critical Pathways↗
PubMed1999

The ethics of using contingency management to reduce pressure ulcers: data from an exploratory study.

Although there is a widely held argument that pressure ulcers are preventable, they continue to cause major healthcare and financial problems. The blame for pressure ulcers has typically focused on the patient's self-neglect or self-destructiveness. However, more recently, there has been a call for a paradigm shift from the current "paternalistic" medical model to one that includes the patient as a participant in his or her own care. Contingency management, a procedure well known in behaviorism, is presented as one such possibility. Controversy about the use of monetary reward, as well as discussion of initial efficacy in a current study, are discussed.

Adult↗
PubMed1999

Using telemedicine in the treatment of pressure ulcers.

Pressure ulcers are dynamic and therefore require frequent assessment and immediate treatment. For many patients who live long distances from rehabilitation hospitals, frequent assessment and immediate treatment are often unavailable. Recent advances during the last two decades have resulted in the development of telemedicine--long-distance delivery of medical education and services to patients. This pilot study reports on a patient enrolled in a telemedicine program during his fifth hospitalization for pressure ulcers in 16 months. Although this is only a single case study, the results suggest the potential efficacy of this new intervention.

Adult↗
PubMed1998

Clinical comparison and performance perspective of three aligning arch wires.

OBJECTIVES: To clinically evaluate three commonly used orthodontic tooth aligning arch wires: 016 x 022 inch active martensitic medium force nickel titanium, 016 x 022 inch graded force active martensitic nickel titanium, and 0.0155 inch multistrand stainless steel. DESIGN: A prospective randomized clinical trial. DATA SOURCE: Measured serial study casts of dental arches for 112 assigned arch wires from 56 consecutive patients. Analysis based on completed records for 98 arch wires and 51 patients. METHOD: A consecutive sample of 56 patients requiring both upper and lower fixed appliance therapy were randomly allocated two different arch wires from a possible three under trial. Good quality impressions were taken of the dental arches at the designated serial stages of alignment (start, T0; 4 weeks, T4; 8 weeks, T8). The resultant casts were measured on a Reflex Microscope to record the change in individual tooth alignment both in three and two dimensions (horizontal plane only). RESULTS: The measurement error was within acceptable limits (range, 0.05 to 0.09 mm) and showed no significant bias. ANOVA statistical models were fitted to the data to adjust for a number of variables. No significant difference in aligning capability (p > 0.05), in either two or three dimensions, was demonstrated between the three arch wires in the trial. CONCLUSION: Heat activated nickel titanium arch wires failed to demonstrate a better performance than the cheaper multistrand stainless steel wires in this randomized clinical trial. The failure to demonstrate in vivo superiority at the clinical level may be due to the confounding effects of large variations in individual metabolic response. Alternatively, it may be that in routine clinical practice NiTi-type wires are not sufficiently deformed to allow their full superelastic properties to come in to play during initial alignment.

Analysis of Variance↗
PubMed1998

Using telerehabilitation to support assistive technology.

Telerehabilitation--the use of telecommunications technology to provide rehabilitation and long-term support to people with disabilities--offers exciting possibilities for the delivery and support of assistive technology services. This article describes the experiences of a specialty hospital serving persons with disabilities in exploring telerehabilitation to support assistive technology use in the home. Four case studies are presented to illustrate how telerehabilitation may be used in relation to seating evaluation, evaluation of home accessibility, setup of computer access systems, and training in use of augmentative communication devices.

Persons with Disabilities↗