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Biomedical subjects

P E Stevens

Publications and source records attributed to P E Stevens.

At least 19 recordsLinked to original sources
PubMed2005

Severe acute renal failure in adults: place of care, incidence and outcomes.

BACKGROUND: Department of Health guidelines recommend specialist critical care facilities for patients with severe single-organ failure such as acute renal failure (ARF). Prospective studies examining incidence, causes and outcomes of ARF outside of intensive care settings are lacking. AIM: To determine the incidence, causes, place of care and outcomes of severe single-organ ARF. DESIGN: Prospective observational study. METHODS: For 6 weeks in June-July 2003, renal physicians were contacted daily, and ICUs on alternate days, to identify cases of severe single-organ ARF in the Greater Manchester area. All patients with serum creatinine >or=500 micromol/l and not requiring other organ support were included. Patients with end-stage renal disease were excluded. Survivors were followed up at 90 days and 1 year from admission. Two independent consultant nephrologists assessed each case using anonymized summaries. RESULTS: Eighty-five patients had multi-organ ARF and 28 had severe single-organ ARF (380 and 125 pmp/year, respectively). Of those with single-organ ARF, 10 (36%) had known pre-existing chronic kidney disease. Renal replacement therapy (RRT) was required in 15 (54%). Total bed occupancy on ICUs relating to single-organ ARF was 59 days (range per patient 1-21). At 90 days, 18 (64%) were alive, and 17 (94%) had independent renal function. At 1 year, 4/18 had died, none receiving RRT at the time of death. Survivors all had independent renal function. In 13 (46%) cases there was an unacceptable delay in patient transfer and in 7 (25%), delays in assessment or commencement of RRT may have adversely affected patient outcome. DISCUSSION: The incidence of ARF treated with RRT is rising. Delays in transfer to renal services may result in inappropriate ICU bed use, and may adversely affect patient outcomes. There are serious problems regarding the appropriate use of expensive and limited medical resources in the critical care area, and in providing safe and effective treatment of patients with ARF.

Acute Kidney Injury↗
PubMed2005

Experience of 5-aminosalicylate nephrotoxicity in the United Kingdom.

AIM: To study 5-aminosalicylate nephrotoxicity in patients with inflammatory bowel disease in the UK. METHODS: A detailed postal questionnaire was sent to all 1298 names in the British Society of Gastroenterology database and 290 consultant members of the Renal Association. The British Society of Gastroenterology reported new cases monthly, the Renal Association 6 monthly. Results were expressed as estimated glomerular filtration rate. RESULTS: Retrospective study: cases--British Society of Gastroenterology:Renal Association 202:87, aged 15-76 years. Median peak (range) creatinine (British Society of Gastroenterology:Renal Association) - 300:301 (78-1200) micromol/L. Prospective study - 59 cases, median age 52 years (M:F ratio: 47:12). Median pre-treatment estimated glomerular filtration rate: 76.9 (123.9-39), at diagnosis 28.4 (80.5-3.6, creatinine range: 92-1361 micromol/L), recovery 46.8 [111.2-end stage renal failure] mL/min/1.73 m2. Recovery of renal function was significantly improved for patients treated for < 12 months [n = 10, median recovery estimated glomerular filtration rate 70.5 (92-26.9) vs. > 12 months 38.4 (111.2-end stage renal failure) mL/min/1.73 m2, P = 0.028]. CONCLUSIONS: Regular monitoring of renal function may allow earlier detection of nephrotoxicity, particularly during the first year of therapy. Based on an inflammatory bowel disease prevalence in the United Kingdom of 412 x 10(5) with about 50% on treatment, we estimate that the incidence of clinical nephrotoxicity in patients taking 5-aminosalicylate therapy is approximately one in 4000 patients/year.

Adult↗
PubMed2003

Stability of parathyroid hormone ex vivo in haemodialysis patients.

BACKGROUND: The stability of parathyroid hormone (PTH) in blood ex vivo is a significant practical problem for laboratories and clinicians. Several studies have suggested that PTH is more stable in blood collected into a potassium edetate (EDTA) preservative. METHODS: To confirm that this was applicable to renal dialysis patients using our assay (Nichols chemiluminescence), we examined PTH stability in 13 patients with end-stage renal failure using three different blood collection tubes. RESULTS: PTH remained stable in EDTA plasma for up to 48 h at room temperature. PTH was significantly reduced in serum collected into plain tubes after 2 h, and after 4 h in serum collected into serum separator tubes, at room temperature. CONCLUSION: In the assessment of renal osteodystrophy, the use of EDTA plasma can confer significant benefit, especially in busy laboratories where rapid frozen separation of blood may be hard to achieve.

Edetic Acid↗
PubMed2001

Midlife women's experiences living with heart disease.

The purpose of this paper is to report results from a qualitative field study of 15 women with heart disease. The study was conducted over a two-year period in a number of clinical settings to document women's subjective experiences after angioplasty or cardiac surgery. The phenomena of interest were participants' perceptions of their health, the impact cardiac illness was having on their lives, lifestyle changes they had engaged in since diagnosis, and how they felt about having heart disease. Qualitative content analysis was applied to field notes and in-depth interviews. The overall sense of living with heart disease for these midlife women was one of paradox. Implications of their contradictory experiences are discussed as they apply to nursing practice.

Adaptation, Psychological↗
PubMed2001

Non-specialist management of acute renal failure.

In a 12-month prospective study of the initial management of patients with acute renal failure (ARF) in East Kent (population 593 000), we evaluated the initial management of ARF and assessed what proportion of ARF may have been preventable. Patients were seen and assessed on a daily basis, and were followed until discharge from hospital or death; survivors were subsequently followed for 3 years. Overall, 288 patients developed ARF (486 per million population/year). Mean age at presentation was 73 years (range 14-96). Initial assessment was often suboptimal, and key features in investigation and initial management were often lacking. In 108 cases, ARF was iatrogenic and/or potentially preventable (53 preventable, 99 iatrogenic, 44 both). Overall survival was 56% at discharge from hospital, 35% at 1-year follow-up, 31% at 2 years, and 28% at 3 years. In discharged patients, recovery of function was complete in 69%. A significant proportion of ARF is preventable. Clear guidelines, easily accessible at the point of care, could aid the diagnostic evaluation of the patient with ARF and indicate where referral for a specialist opinion is appropriate.

Acute Kidney Injury↗
PubMed2001

Inclusion of children in clinical research: lessons learned from mothers of diabetic children.

Nine mothers of diabetic children participated in a qualitative study about the factors that influenced them to consent to have their children involved in clinical research. They were asked to describe how they made decisions about involving their children in research, what motivated them to keep their children in research once they were enrolled, and how they evaluated the clinical studies their children had been in. Results suggest that mothers engage in a personal calculus before making a choice to consent.

Adult↗
PubMed2000

Assessment of quality of life in a single centre dialysis population using the KDQOL-SF questionnaire.

Health-related quality of life (HRQOL) is a valid marker of outcome for chronic dialysis therapy. A wide range of questionnaires are now available which assess different aspects of an individual's health. Appreciation of those factors that contribute to explaining HRQOL items remains poorly defined. The development of disease-specific questionnaires such as KDQOL-SF, should allow for such questions to be better answered. A cross-sectional analysis of our chronic dialysis population was made using the KDQOL-SF questionnaire. By multiple linear regression analysis demographic, clinical and dialysis-related factors were assessed for their contribution to the HRQOL in this population. The HRQOL of these patients was also compared against a general population sample. From a total of 190 chronic dialysis patients, 146 completed the KDQOL-SF questionnaire. The haemodialysis (HD) and peritoneal dialysis (PD) patients were similar with respect to most demographic, clinical and dialysis variables except for haemoglobin and albumin which were significantly (p < 0.05) greater in the peritoneal and haemodialysis populations respectively. Compared to the general population, the HRQOL of dialysis patients was impaired for all SF-36 subscales. Use of the disease-specific components of KDQOL-SF discriminated between dialysis modality for our dialysis population. Multiple linear regression analysis demonstrated that 27.5 to 42.7% of the variance in the SF-36 subscales could be explained. Satisfactory sleep, dialysis related symptoms, effect of kidney disease on lifestyle and burden of kidney disease were found to be the most important determinants of HRQOL for this population.

Aged↗
PubMed2000

Review article: interstitial nephritis associated with the use of mesalazine in inflammatory bowel disease.

5-Aminosalicylic acid (5-ASA) has replaced sulphasalazine as first line therapy for mild to moderately active inflammatory bowel disease and is widely used. A number of reports have linked oral 5-ASA therapy to chronic tubulo-interstitial nephritis and this relationship is now well established. Despite increasing recognition of the potential for this serious adverse event, guidelines for monitoring renal function in patients prescribed 5-ASA preparations are not widely employed. Whilst the incidence of this adverse event in the population of patients with inflammatory bowel disease treated with mesalazine is low, the morbidity in an affected individual is high with some cases progressing to end-stage renal disease. Routine monitoring of renal function is simple and inexpensive and could prevent this outcome. Based on the available data, serum creatinine should be estimated prior to commencing treatment, monthly for the first 3 months, 3-monthly for the next 9 months, 6-monthly thereafter and annually after 5 years of treatment.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2000

A nursing critique of US welfare system reform.

In 1996, the Aid to Families with Dependent Children program was repealed, and the welfare system in the United States was changed. This article critiques, from a nursing perspective, US welfare system reform. It interrogates dominant ideologies about poverty, welfare, and waged labor; examines federal welfare reform legislation of the 1990s and its programmatic implementation at the state level; discusses global health and safety implications of welfare replacement initiatives; and challenges nurses to political and scholarly action.

Aid to Families with Dependent Children↗
PubMed1998

Participatory action research for sustaining individual and community change: a model of HIV prevention education.

The authors describe the implementation, results, and evaluations of a participatory action research project in which they used qualitative methods to do HIV prevention education with lesbians and bisexual women. This grassroots project combined collective consciousness-raising, qualitative field interviewing, and individualized HIV prevention education in an experientially intense intervention sustained over a 2-year period in community sites. Systematic data collection about HIV risk taking among lesbians and bisexual women was conjoined with efforts to mobilize the community for behavior change to prevent HIV. A cadre of peer educators conducted 1,189 field interviews and produced 55 HIV prevention presentations with a total of 3,665 women in attendance. Key findings describe the HIV risk taking common in this population and their needs for support in reducing risk. Process evaluations of the project suggest that its combined individual and group approach and its continuity over time were effective. Outcomes suggest that the project positively affected participants' intent to change risk behaviors, supported incremental changes to reduce risk, assisted participants in the interpersonal realm of partner negotiations, and began to change community conventions about sexual expectations and practices.

Adult↗
PubMed1997

Trauma of discovery: women's narratives of being informed they are HIV-infected.

The purposes of this research report are to describe women's subjective experiences of being informed of a positive HIV antibody test and, from their point of view, to explain the meaning and impact of discovering that one is HIV-infected. In this qualitative narrative study, a racially diverse, low-income sample of 38 HIV-infected women shared their stories of HIV discovery during in-depth interviews. Findings of a multi-staged narrative analysis suggest that, for women like those in this study, the discovery of HIV seropositivity is a traumatic event, carrying with it elements that are common to other types of trauma: perceived threat to one's life and perceived responsibility for the deaths of others. Overarching personal meanings, or metaphors, framed these women's experiences of the trauma of HIV discovery. HIV discovery was an epiphany for 10% of the sample, a confirmation for 37%, and a calamity for 53%. Among their calamitous reactions were shock, fear, anguish, and suicidality. The impact of learning that they were HIV-infected often took its toll in unrelenting misery, escalated drug use, transmission risks, and destabilization of relationships, income, and shelter. Extensive excerpts from participants' interviews illustrate analytic findings. Implications for counselling and follow-up at diagnosis and early in the course of HIV illness are elaborated.

Adult↗
PubMed1997

A descriptive study of the handwashing environment in a long-term care facility.

The authors present a clinical research project accomplished by a nurse during her first year of practice after graduating from a B.S.N. program. In her caregiving at a long-term care facility subacute unit, she was unable to do proper handwashing. The poorly placed pump-style paper towel dispensers were inadequate for the task. She knew that handwashing before and after resident contact is the single most effective infection control measure to prevent nosocomial infections. In consultation with her university professor, she designed and implemented a descriptive study of the facility's handwashing environment. She mapped and measured handwashing areas, explained constrictions the environment placed on handwashing technique, collected random cultures from the sinks and dispenser levers, and illustrated for administrative and auxiliary personnel the basic principles of microbiology. Implications for infection prevention and control in long-term care facilities are discussed in light of increased "high-end skilled nursing" being offered in subacute units.

Aged↗
PubMed1996

Mesalazine-associated interstitial nephritis.

BACKGROUND: When used for oral treatment of inflammatory bowel disease, Asacol (a coated form of mesalazine = 5-aminosalicylic acid) can cause interstitial nephritis. The spectrum of severity, frequency of occurrence and the best renal function test to detect this complication are not known. The value of immunosuppression in addition to drug withdrawal is similarly undetermined. METHODS: Four cases of interstitial nephritis which occurred in association with oral Asacol treatment are presented and a further 12 cases who received similar treatment are reviewed. Clinical trials published previously were scrutinized to assess the frequency of impaired renal function. RESULTS: The available evidence suggests that renal impairment of any severity may occur in up to 1 in 100 patients, but that clinically significant interstitial nephritis occurs in less than 1 in 500 patients. This is most reliably detected by an elevated serum creatinine concentration. If the diagnosis of nephrotoxicity is delayed until 18 months after commencement of medication, restoration of renal function, which is seen on withdrawal of medication alone up to 10 months, does not occur and there is no evidence to date to indicate that addition of immunosuppression confers any significant advantage at this later stage. CONCLUSIONS: It is suggested that serum creatinine concentration should be measured each month for the first 3 months of treatment, 3-monthly for the remainder of the first year and annually thereafter. The use of concurrent immunosuppressive therapy may necessitate extension to the period of intensive monitoring. Any elevation of serum creatinine which cannot be related to a relapse of inflammatory bowel disease should prompt immediate withdrawal of Asacol and related medications and substitution of alternative therapy. Neither the lack of urinary abnormalities on routine testing nor the absence of clinical or laboratory features of drug allergy can be relied upon to rule out interstitial nephritis during oral therapy with these drugs.

Administration, Oral↗
PubMed1996

An occupational transmission of HIV: collision of ethical worlds in nursing practice.

This article proposes a new theoretical frame for ethical practice in nursing by locating ethical questions within the worlds of everyday nursing experience. The authors advocate a process of ethical thought and action that is not so much a weighing of dichotomized alternatives as a continual journey in which nurses delve deeper into their examination of clinical contexts, structural contingencies, and the meanings of experience for themselves and their clients. This theoretical vision is illustrated with a case study about a nurse who was infected with HIV on the job. The purposes in presenting the case study are to give testament to this brave woman's story, illustrate the dynamics of a contextualized ethics, and challenge nurses to make changes in practice, policy, and structure to foster truly ethical work and relations with others.

Attitude of Health Personnel↗
PubMed1996

Focus groups: collecting aggregate-level data to understand community health phenomena.

Focus-group method is an apt strategy for studying community health phenomena at the aggregate level. Not only can its use facilitate the inclusion of segments of the population who have been underserved by previous research, but it can generate a depth of understanding about public health problems, community strengths, and potential interventions that have local meaning and utility. Advantages and potential uses of focus groups are explored, as well as purposes and processes of focus-group interviewing, strategies for analysis, methodological limitations, and implications for practice and policy. The author presents investigatory examples to illustrate how focus-group method expands on the possibilities of individual interviewing to explore community interpretations and understand the health needs and experiences of an aggregate.

Adult↗
PubMed1996

Struggles with symptoms: women's narratives of managing HIV illness.

The purpose of this research report is to derive a holistic view of the symptom experiences of women living with HIV/AIDS. A racially diverse sample of 38 HIV-infected women participated in in-depth narrative interviews describing their perceptions, evaluations, and responses related to HIV symptoms. Findings suggest a pattern to their struggles with symptoms: They experienced an accumulation of overwhelming symptoms, grew intensely fearful of these symptoms and what it meant to have HIV, and acted to protect themselves from allowing the HIV to "take hold". Many women perceived health care contact and cooperation with prescribed regimens as avenues for HIV to "take over" their lives, so they avoided these actions. Exemplar narratives illustrate analytic findings.

Adaptation, Psychological↗