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Biomedical subjects

N Wells

Publications and source records attributed to N Wells.

At least 19 recordsLinked to original sources
PubMed1999

A cost analysis on the pattern of asthma prescribing in the UK.

There is a need to establish the proportion of adult asthmatics at each step of the recommended asthma management guidelines, the cost of their prescribed treatment, and a revised cost of treatment assuming patients who were suboptimally controlled were moved up a step. Actual prescription and cost figures and a theoretical projection of an ideal scenario was calculated from a sample of general practices in Great Britain from the Doctors Independent Network. They comprised 102 nationally distributed practices and 17,206 adult patients with a diagnosis of, and prescription related to, asthma recorded between October 1993 and March 1994. Ninety-one per cent of patients received treatment within a recognized step of the guidelines. Of these, 80% were at steps 1 and 2. Employing excess inhaled beta-agonist use as a proxy for control of asthma, between 55% and 69% of patients at Steps 1-3 should receive treatment at a higher step. This could lead to an increased expenditure of up to Pound Sterling 4.66 per adult patient per month. This would imply a rise in the annual UK cost of antiasthma prescriptions for adults from Pound Sterling 388m to a possible Pound Sterling 533m. The United Kingdom Government audit commission has suggested that current expenditure on asthma treatment appears to be insufficient. Using an entirely different approach this study has confirmed that a significant increase in asthma prescribing costs is likely to be needed if optimal control of asthma is to be achieved.

Adolescent↗
PubMed1999

Parent coping and child distress behaviors during invasive procedures for childhood cancer.

This study examines what parents identified as their primary stressor before their child's invasive procedure, what coping strategies were used to manage the stress, what level of distress their children experienced during each phase of the procedure, and whether parents' coping modes were associated with their children's distress. Twenty children with cancer from 3 to 11 years of age and the parent present during the procedure participated in the study. Parents' primary stressors were identified as uncertainty about parent role and anticipating the child's distress during the procedure. Although parents used both emotion-focused and problem-focused strategies for coping with their primary stressors, they primarily relied on emotion-focused strategies. Children experienced the most behavioral distress during the procedural phase, and girls exhibited more distress than boys. The parents' coping modes were not associated with their children's distress, but children of parents whose primary stressor was uncertainty about parent role had higher distress than children of parents whose primary stressor was anticipating the child's distress. The findings related to parents' stressors, their coping strategies, and their children's distress were consistent with previous research. Directions for future research and suggestions for dealing with invasive procedures for childhood cancer are described.

Adaptation, Psychological↗
PubMed1998

Development of a short version of the Barriers Questionnaire.

Among the reasons that cancer pain is not controlled adequately are patient-related barriers. Patient beliefs that may contribute to poor outcome have been measured in previous research with the Barriers Questionnaire (BQ). The purpose of this study was to examine the internal consistency of a shortened version of the BQ. A sample of 217 outpatients with cancer completed a 17-item version of the scale. Factor analysis suggested two subscales, one reflecting beliefs about communication about pain and the other reflecting beliefs about the use of analgesics. Both subscales demonstrated adequate internal consistency. Beliefs did not differ between patients who had and those who had not experienced pain within the previous two weeks. Findings suggest the shortened BQ provides an internally consistent measure of two broad patient barriers to pain management.

Adolescent↗
PubMed1998

Interdisciplinary collaboration.

This quasiexperimental study investigated interdisciplinary collaboration over a 16-month period on units using different collaborative practice strategies. Measures of collaboration and perceived physician involvement in collaborative practice were completed by 335 licensed staff members working on seven general adult units in an acute care hospital located in an academic medical center. Data were collected at two time points: in 1993 and 1995. A small but statistically significant decline in collaboration was found (p = 0.01) over the 16-month period. Analysis of variance revealed a significant difference (p = 0.03) in collaboration related to the method used to develop collaborative paths. Post hoc Tukey's test indicated that the presence of a case manager without collaborative paths did show higher levels of collaboration (p = 0.05). Regardless of the strategy used, perceived high physician involvement was related to greater collaboration than perceived low involvement with differences increasing over time (p = 0.02). These findings suggest the importance of perceived physician involvement in collaborative practice to interdisciplinary collaboration.

Adult↗
PubMed1998

Work transitions.

The healthcare environment is changing rapidly. Work reorganization and redesign can lead to department and unit closures, resulting in work transitions for many staff members. The authors describe the findings of focus groups held with staff and management on units that have closed. These interviews highlight the difficulties encountered with change and provide suggestions to reduce uncertainty during department or unit closures.

Academic Medical Centers↗
PubMed1998

An explanatory model of the dental care utilization of low-income children.

OBJECTIVES: Factors related to the utilization of dental care by 5- to 11-year-old children from low-income households were investigated using a comprehensive multivariate model that assessed the contribution of structure, history, cognition, and expectations. The influence of dentist-patient interactions, psychosocial and health beliefs, particularly fear of the dentist, on utilization were investigated. METHODS: Children were chosen randomly from public schools, and 895 mothers were surveyed and their children were interviewed in the home. Utilization was studied during the 1991-1992 school year, including a 6-month follow-up period after the interview. RESULTS: The overall utilization rate was 63.2%, and the rate for nonemergent (preventive) visits was 59.9%. Utilization was unrelated to actual oral health status. Race and years the guardian lived in the United States were predictive of an episode of care. Preventive medical visits and perceived need were strong predictors of a visit to the dentist, as were beliefs in the efficacy of dental care. Mothers who were satisfied with their own care and oral health and whose children were covered by insurance were more likely to utilize children's dental care. In contrast, child dental fear and absences from school for family problems were associated with lower rates of utilization. CONCLUSIONS: Mutable factors that govern the use of care in this population were identified. These findings have implications for the design of dental care delivery systems for children and their families.

Adult↗
PubMed1997

Rooming-in for elderly surgical patients.

Elderly patients are at risk for developing acute confusion during hospitalization. Rooming-in, an intervention frequently used for pediatric patients, was compared to usual care in a sample of 24 elderly patients hospitalized for orthopedic surgery. Although confusion during hospitalization, complicate rate, and length of stay did not differ between patients who did and did not have rooming-in, the family members and friends who roomed in were very satisfied with the experience. These findings suggest that rooming-in is feasible and highly satisfactory to the patient's family and/or friends.

Acute Disease↗
PubMed1997

Smoking cessation in military personnel.

Tobacco use is the single most important preventable cause of death in military personnel. The purpose of this randomized clinical trial was to evaluate the effectiveness of two behavioral interventions when added to nicotine-replacement therapy on smoking cessation. The sample of 512 included 52% active duty military, 29% family, 11% retirees, and 8% Department of Defense civilians. There was a main effect of compliance at the end of the program (EOP); 69% of those who attended 75% of the classes were abstinent from tobacco; regression analysis found the more intensive program to be twice as effective at EOP and at 3 months, an outcome not continued at 6 months. The longer, more intensive Vanderbilt University Medical Center program was significantly more effective at helping the civilian portion of the population (85% versus 60% in the American Cancer Society program) but not the active duty participants.

Adult↗
PubMed1996

Role transition: from clinical nurse specialist to clinical nurse specialist/case manager.

Changes in the healthcare environment provide the impetus to look closely at the way in which patient care is delivered. Complex health problems, requiring the expertise of multiple healthcare specialists, coupled with complex hospital systems, result in fragmented care that is confusing to patients and their families. Case management by nurses working closely with physicians in hospitals is one strategy that can reduce fragmentation of care. Case management also facilitates the delivery of cost-effective patient-focused care. Because of his her expertise, the clinical nurse specialist (CNS) is an ideal choice for the role of case manager. The authors describe the role transition of nurses from CNS to CNS case manager over a 2-year period and identify the key system supports required to ensure successful evolution into this expanded role.

Career Mobility↗
PubMed1996

Effect of backrest position on hemodynamic and right ventricular measurements in critically ill adults.

BACKGROUND: Hemodynamic measurements are often obtained with the patient in a flat, supine position. Reports suggest that these measurements can be reliably obtained at backrest elevations from 0 degree to 45 degrees. However, no study has been performed to evaluate the effects of position change on all the measurements that can be obtained via a pulmonary artery catheter. OBJECTIVE: To investigate the effects of backrest elevation of 0 degree, 30 degrees, and 45 degrees on measurements obtained via a pulmonary artery catheter. METHOD: Thirty-nine patients in an ICU at a university-based hospital, who required a pulmonary artery catheter, were studied. A single-group, repeated-measures design was used. Hemodynamic and volumetric measurements were obtained from all subjects. RESULTS: Repeated-measures analysis of variance revealed that differences in cardiac index were statistically significant, and differences in cardiac output approached statistical significance. However, examination of the means of these measurements indicates a clinically nonsignificant difference in these values. No statistically or clinically significant differences were found for the other hemodynamic or volumetric measurements studied related to the order of backrest elevation. CONCLUSION: Findings support the hypothesis that a patient need not be placed flat to obtain accurate hemodynamic and volumetric measurements. Results of this study are consistent with those of previous research and extend previous results to include the volumetric measurements of end-diastolic volume index and right ejection fraction. In addition, the use of mechanical ventilation and vasoactive drugs did not alter the accuracy of the measurements at backrest elevations from 0 degree to 45 degrees.

Adolescent↗
PubMed1994

Perceived control over pain: relation to distress and disability.

The relationship between perceived control over pain and outcomes of distress and disability were studied in a sample consisting of 71 patients with chronic nonmalignant pain. The pain-related control belief subscales measured three aspects of control: lack of control, ability to cope, and negative outcome expectancy. After controlling for pain intensity, the control belief subscales explained a significant amount of the variance in distress and disability. These findings provide support for cognitive modulation of the distress and disability associated with chronic nonmalignant pain.

Adaptation, Psychological↗
PubMed1994

A survey of practicing nurses' research interests and activities.

We conducted a survey of 279 practicing nurses' research attitudes, past and current research activities, and research resources. Levels of practice included staff nurses, nurse managers, and advanced practice nurses. Three factors were identified from a 15-item research attitudes scale: research value, confidence, and perceived support. Significant differences were found for research value and confidence among three levels of clinical practice. Advanced practice nurses reported higher research value and confidence than did staff nurses and nurse managers. Most respondents reported using research findings in practice, but only a small percentage were conducting research. Factors related to research conduct and use differed. Suggestions are offered for methods to increase the value of research by practicing nurses.

Adult↗
PubMed1994

Dosimetry of effective wedge fields produced by an internal wedge.

A procedure is described to calculate the monitor unit ratios required to produce effective wedge fields having a desired wedge angle by combining an internal 60 degrees wedge with an open field. Complementary procedures are derived and demonstrated for calculating the effective wedge dose distributions with wedge angles of 15 degrees, 30 degrees, and 45 degrees using the central axis depth dose data and off-axis ratios of the open field and the 60 degrees wedged field. Measurements at five points on and off the central axis within each field and measurements of the effective wedge factor demonstrated that the calculated wedge distributions were correctly delivered to within 2% in all cases.

Biophysical Phenomena↗
PubMed1994

A national survey of asthma prevalence, severity, and treatment in Great Britain.

Parents of 5472 children aged 5-17 years from 3209 families were interviewed in a nationwide household survey. In the past year, 15.0% of children had wheezed, 2.2% had more than 12 attacks, and 2.3% had experienced a speech limiting attack. Altogether 4.3% were woken more than once a week by wheezing, 13.1% had doctor diagnosed asthma, and 13.6% had been prescribed antiasthmatic drugs in the past year. With increasing age, morbidity related to wheezing declined to a greater extent than annual period prevalence. The prevalence of wheeze varied little by socioeconomic group, but there were marked trends in all three indices of severity towards increased morbidity in poorer families. Diagnostic labelling and drug treatment of wheezy children did not differ substantially with socioeconomic status. Thus, a degree of socioeconomic equality exists in the process of medical care for childhood asthma in Britain. This does not appear to have resulted in equality of outcome.

Adolescent↗
PubMed1993

Different motion sensitive units are involved in recovering the direction of moving lines.

We studied direction discrimination for lines moving obliquely relative to their orientation. Manipulating contrast, length and duration of motion, we found systematic errors in direction discrimination at low contrast, long length and/or short durations. These errors can be accounted for by a competition between ambiguous velocity signals originating from contour motion processing units and signals from line terminator processing units. The dynamic of this competition can be described by a simple model involving two different classes of processing units with different contrast thresholds, different integration time constants and different levels of response saturation.

Computers↗
PubMed1993

The real costs of emesis--an economic analysis of ondansetron vs. metoclopramide in controlling emesis in patients receiving chemotherapy for cancer.

The cost effectiveness of ondansetron was compared with that of metoclopramide in the prevention of acute emesis due to highly emetogenic chemotherapy in an open, randomised, parallel group pilot study. Ondansetron was given as three 8 mg intravenous doses (0, 4 and 8 h) and metoclopramide as an intravenous loading dose (3 mg/kg) followed by a maintenance dose of 0.5 mg/kg/h for 8 h. Therapeutic outcomes and full utilisation costs, that is nursing time, material costs, in addition to drug acquisition prices were recorded for each antiemetic for 24 h following chemotherapy. The cost per successfully treated patient (< or = 1 emetic episode and no adverse events) was 95.20 pounds for ondansetron and 92.18 pounds for metoclopramide. The results of the study therefore suggest that for the control of acute emesis due to highly emetogenic chemotherapy ondansetron and metoclopramide are equally cost-effective treatments.

Antineoplastic Agents↗