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Biomedical subjects

M Sinclair

Publications and source records attributed to M Sinclair.

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

Project-based learning.

Architecture and nursing and midwifery students worked with employers from local trusts on a project exploring design issues for a new maternity unit. Marlene Sinclair and George Brown report on how it was organised, and the benefits for students and employers.

Architecture↗
PubMed1998

Labour ward midwives' perceptions of stress.

This exploratory study set out to examine labour ward midwives' perceptions of stress. It utilized a combination of two self-report questionnaires, one devised by McGrath et al. and the GHQ12. Additional qualitative data were collected by asking midwives to produce narratives about recent stressful events. A convenience sample of the 43 midwives formed the study population and a response rate of 77% was achieved. Quantitative data were analysed using descriptive statistics and qualitative narratives were explored for content analysis. Midwives in this study demonstrated their awareness of stress in their working and personal lives and many took active steps to redress the negative effects with exercise, hobbies and talking with colleagues. However, the study revealed that 78% of the midwives indicated that having insufficient time to perform their duties was very stressful, paralleled by their perceived inability to influence work-based decisions. The study revealed that both medical and midwifery colleagues frustrated their endeavours to change an unsatisfactory condition. The GHQ12 revealed 30% of the midwives had scores above the threshold level of 2 indicating psychiatric morbidity and this is of major concern. The narratives revealed that lack of communication between the professionals about decision making was a major source of stress and as a result of this study efforts to improve multidisciplinary communication through the development of journal clubs and planned social activities is under consideration by the unit. Overall, the findings from this study highlight stress as a potential, occupational health problem in the working lives of some labour ward midwives.

Adult↗
PubMed1997

Nurse teachers' perceptions of information technology: a study of nurse teachers in Northern Ireland.

This paper presents the results of a brief study of Northern Ireland nurse educators' perceptions of information technology (IT) in nurse education. The study focuses on training, computer use, student assessment, and future trends. The results indicate that although there remain tutors who have not received any formal training in computer use, the majority want to use computers and recognize their need for competence. While training would appear to have a positive effect on their perceived level of competence and computer knowledge, the study identifies factors which contribute to the restricted use of computer assisted learning (CAL). Student assessment varies across the province and findings of the study indicate that although many changes have taken place, staff expect more in the future. They identify a need for policies that include training programmes, competence assessment, appropriate technology, and networking.

Adult↗
PubMed1993

Does modern cardiac surgery require conventional intensive care?

We considered that, with modern perfusion equipment and mildly hypothermic cardiopulmonary bypass, protracted post-operative ventilation in an intensive care unit (ITU) is no longer required after most cardiac operations. We used a three-bedded cardiac recovery area (CRA) within the operating suite for 1,000 patients between January 1990 and June 1991. Forty-five patients with special needs were managed in the ITU. The time to extubation (T50%; range) for coronary bypass, aortic valve, mitral valve, and double-valve patients was 2.0 (0-42), 2.5 (0-12), 3.0 (0-15), and 3.0 (1-36) hours, respectively. Recovery beds were re-used allowing 5-6 operations daily. The difference in nursing staff complement for a CRA versus ITU bed was 4.5/7.8. Patient management was by nurse specialists supported by cardiac surgeons. Intervention by cardiac anaesthetists or intensivists was limited to specific ventilatory problems or renal failure. The early extubation policy failed in ten patients (five coronary, three aortic, one mitral and one double-valve patient) through poor pre-operative respiratory function, left ventricular failure or intra-operative events. The overall mortality in CRA was 1.4%. The mean duration of post-operative stay was 7 days (range 5-12). We conclude that a CRA staffed by nurse practitioners provides a safe and effective alternative to the anaesthetist-managed ITU. A rapid turnover of CRA beds removes the constraints of ITU bed availability.

Adolescent↗
PubMed1993

The effect of a cardiac surgical recovery area on the timing of extubation.

The anesthetic and postoperative management of cardiac surgical patients was modified to achieve an early return to spontaneous ventilation. A total of 278 patients were studied to determine the effect of this change. Patients in group I (n = 198) were managed in a cardiac surgical recovery area according to the new policy. Group II (n = 80) was a comparable group of patients operated upon before this change. The median duration of postoperative ventilation was reduced from 5 hours in group II to 1 hour in group I, and the time to extubation was reduced from 7 hours to 2 hours, respectively. There were no major postoperative complications resulting from this change. The factors that influence the duration of postoperative ventilation are discussed.

Adult↗
PubMed1993

Amiodarone prophylaxis for tachycardias after coronary artery surgery: a randomised, double blind, placebo controlled trial.

BACKGROUND: Arrhythmias are a common cause of morbidity after cardiac surgery. This study assessed the efficacy of prophylactic amiodarone in reducing the incidence of atrial fibrillation or flutter and ventricular arrhythmias after coronary artery surgery. METHODS: A double blind, randomised, placebo controlled trial. 60 patients received a 24 hour intravenous infusion of amiodarone (15 mg/kg started after removal of the aortic cross clamp) followed by 200 mg orally three times daily for 5 days, and 60 patients received placebo. RESULTS: 6 patients (10%) in the amiodarone group and 14 (23%) in the placebo group needed treatment for arrhythmias (95% confidence interval (95% CI) for the difference between groups was 0 to 26%, p = 0.05). The incidence of supraventricular tachycardia detected clinically and requiring treatment was lower in the amiodarone group (8% amiodarone v 20% placebo, 95% CI 0 to 24%, p = 0.07). The incidence detected by 24 hour Holter monitoring was similar (17% amiodarone v 20% placebo). Untreated arrhythmias in the amiodarone group were either clinically benign and undetected (n = 3) or the ventricular response rate was slow (n = 2). Age > 60 years was a positive risk factor for the development of supraventricular tachycardia in the amiodarone group but not in the placebo group. Fewer patients had episodes of ventricular tachycardia or fibrillation recorded on Holter monitoring in the amiodarone group (15% amiodarone v 33% placebo, 95% CI 3 to 33%, p = 0.02). Bradycardia (78% amiodarone v 48% placebo, 95% CI 14% to 46%, p < 0.005) and pauses (7% amiodarone v 0% placebo) occurred in more amiodarone treated patients. Bradycardia warranted discontinuation of treatment in one patient treated with amiodarone. CONCLUSIONS: The incidence of clinically significant tachycardia was reduced by amiodarone. The ventricular response rate was slowed in supraventricular tachycardia, but the induction of bradycardia may preclude the routine use of amiodarone for prophylaxis.

Adult↗
PubMed1992

Cardiac surgery: moving away from intensive care.

OBJECTIVE: To evaluate outcome in patients managed outside an intensive care unit after open heart surgery. BACKGROUND: The high cost of cardiac surgery is mainly due to the needs of traditional postoperative care. The requirements for intensive care and treatment has decreased with improvements in techniques of cardiac surgery and anaesthesia. In this setting the need to continue to depend on intensive care units for the recovery of cardiac surgical patients is questionable on clinical and economic grounds. DESIGN: Postoperative outcome in 245 patients over a four month period was studied prospectively. PATIENTS: Mean age of the patients was 63.2 years. They underwent a wide variety of operative procedures. Ninety percent of them recovered in a dedicated three bed cardiac surgical recovery area where the management protocol led to rapid extubation and step down in dependency care. RESULTS: Median time for ventilatory support was 90 minutes after transfer to the area. Only five patients were subsequently admitted to the general intensive care unit for prolonged respiratory and cardiac support. Ten patients were electively admitted to the general intensive care unit. Two deaths occurred in hospital in this group (0.8%). Four patients were ventilated for 24 hours in the recovery area itself and made an uncomplicated recovery. CONCLUSION: This study confirms that over 90% of patients undergoing cardiac surgery would recover safely and be treated effectively in a more economical area than intensive care.

Adult↗
PubMed1991

A revised weight loss program in Manitoba Native communities.

In summary a culturally relevant weight loss program should consider the factors of age, education, economics and community. If these factors are not considered then it is the opinion of the author that programs involved with health may not succeed on a reserve.

Health Promotion↗