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P Grocott

Publications and source records attributed to P Grocott.

13 recordsLinked to original sources
PubMed2001

The palliative management of fungating malignant wounds--generalising from multiple-case study data using a system of reasoning.

The project focused on individual experiences, from 45 participants, of living with a fungating wound and the performance of wound dressings in reducing the impact of the wounds on daily living. A case study design was adopted. This posed a key methodological challenge in the form of the contentious epistemological issue, characterised in the literature as the "nomothetic-idiographic dilemma". This issue concerns the nature of knowledge generated from an individual case and its generalisability. A system of reasoning was adopted as the analytic strategy, within a theory-driven evaluation, to abstract general issues from the case study data to construct explanations of symptom control and dressing performance. The latter were generalised beyond the individual cases with the use of theory. This paper focuses on the methodological issues that are inherent in the use of a case study design and the nature of the evidence generated. The system of reasoning is described and illustrated using data from a single participant with advanced uterine cancer and a fungating nodule in the groin.

Activities of Daily Living↗
PubMed2000

The palliative management of fungating malignant wounds.

This study focused on the palliative management of fungating malignant wounds and individual experiences of living with such a wound. Dressings were evaluated for the ability to contain these wounds and reduce their impact on daily life. The project extended to collaboration with industry for the development and evaluation of dressings designed to meet patient needs. A longitudinal multiple case study design was adopted. The methodology evolved through three principal phases: quasi-experimental design; emergent collaborative design; and emergent theory-driven evaluation. The radical departure from the initial approach was in response to the methodological problems encountered in a study of individuals with uncontrolled disease. A non-probability sampling plan was adopted, mainly because of the lack of homogeneity in the patient population; 45 participants were included. The length of time patients remained in the study depended on how long they lived. This ranged from a few days to more than two years. A sampling plan was, however, adopted for the data collection. The study had a dual focus: methodology, and the generation of explanations for dressing performance and the management of fungating wounds. The methodological aspect included development of the Teler system as a method of measuring dressing performance against goals of optimal practice in fungating wound management. The second component was a system of reasoning developed as an analytical strategy for abstracting general issues from individual case study data in order to construct explanations. Theory was used to generalize beyond the individual cases. Two forms of explanation for fungating wound management were constructed. These included explanations of individual experiences of living with such a wound and knowledge of the elements of fungating wound management. The impact on the individual was explained in terms of the stigma attached to public disability and a revulsion in society for uncontrolled body fluids. A pivotal relationship emerged between exudate and other wound management problems, including psychosocial aspects. A final critical explanation was developed for the qualification of the theory of moist wound healing to explain the phenomenon of exudate management in fungating and, possibly, other exuding chronic wounds.

Alginates↗
PubMed1998

Exudate management in fungating wounds.

This study evaluates dressing performance in the management of exuding fungating wounds. The Teler system of treatment evaluation was used to describe the results. The study forms part of a research project on the palliative management of fungating malignant wounds, in which individuals' experiences of living with such a wound were investigated in a multiple-case study design. The conclusions indicate that exudate management depends critically on dressing fit and optimum absorption and venting of excess fluid.

Bandages, Hydrocolloid↗
PubMed1997

Evaluation of a tool used to assess the management of fungating wounds.

This study evaluates the use of the Teler system tool in assessing the effectiveness of dressings used in patients with fungating malignant wounds. The Teler system of clinical evaluation was adapted for the study. This system measures outcomes for the key variables of symptom control, dressing performance and impact of the wound on the patient's daily life by tracing change or lack of change. Data are presented from one patient, and summarised data from 16 additional patients, relating to number of dressing changes, control of exudate and dressing fit.

Bandages↗
PubMed1993

Let us extend our knowledge base. Assessment and management of fungating malignant wounds.

Little research has been undertaken on the management of fungating malignant wounds, and current practice relies more upon an exploratory approach than research-based evidence. This article presents a detailed problem-solving framework for the assessment and management of these wounds, and can be used in conjunction with the wallchart outlining the plan enclosed free with this issue.

Bandages↗
PubMed1987

The viscous layer overlying the corneal posterior epithelium of the domestic cat.

The presence, nature, and composition of a layer of transparent mucinous material overlying the posterior epithelium (called here, 'the viscous layer of the posterior epithelium') was investigated in material from domestic cats. A number of different techniques were used. (a) A variety of different fixatives and histochemical stains was used to preserve and visualise the layer of examination by light microscopy. Frozen sections of fresh material were also examined after on-slide fixation. The preservation and appearance of the viscous layer was critically dependent on the type of fixative used and on minimal agitation during tissue processing. It appeared to contain sulphated acid GAGs, the staining of which was histochemically masked around pH 2.5. The use of frozen sections produced the most reliable preservation of the layer. (b) Ruthenium red or cetylpyridinium chloride was used to preserve the viscous layer for examination by transmission electron microscopy. It appeared in a dispersed form after stabilisation by ruthenium red and in a condensed form after stabilisation by cetylpyridinium chloride. (c) Freeze-dried tissue was examined by scanning electron microscopy. The viscous layer usually appeared as a band of coral- or moss-like material which was often many times the thickness of the posterior epithelium. Usually, the areas of the layer adjoining the posterior epithelium and the anterior chamber appeared more condensed when compared to the material between these two regions. The physiological significance of the viscous layer is discussed.

Animals↗