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Biomedical subjects

P Nolan

Publications and source records attributed to P Nolan.

At least 55 records · Page 3Linked to original sources
PubMed1997

Potassium and ventilation during exercise above and below the ventilatory threshold.

Increases in arterial plasma potassium during exercise may provide an important drive to ventilation. We examined the changes in arterialized venous plasma potassium concentration ([K +]av) and ventilation that occur during sustained exercise at workloads above and below the ventilatory threshold (Vt) in young health humans. After the onset of exercise at a workload below-Vt, [K +]av rose by 0.3 (+/- 0.1) mmol l-1 (mean +/- SEM). Following 30 min of exercise at this intensity [K +]av had fallen (P < 0.05, ANOVA) by an amount approximately equal to one third of the initial increase. While [K +]av fell, ventilation remained stable. At 5 min after the onset of sustained exercise above the Vt [K +]av had risen by 0.7 (+/- 0.1) mmol l-1 and thereafter remained constant. Ventilation slowly increased throughout the above-Vt protocol. These results show significant differences in the time course of the changes in [K +]av and ventilation. They do not support the hypothesis that changes in [K +]a during moderate exercise cause linearly related changes in ventilation.

Adult↗
PubMed1997

Towards a rhetoric of spirituality in mental health care.

The spiritual dimension of care is frequently alluded to in the nursing literature, but rarely examined in terms of what it means in practice or how it might be taught to students entering the profession. Some of those most in need of spiritual care are people suffering from mental illness or psychological distress. The aim of this paper is to explore the different meanings of spirituality and to suggest ways in which the spiritual care of clients can be implemented. It further recommends which aspects of spirituality could usefully be included in nursing curricula. The paper concludes by alerting nurses to the causes and manifestations of spiritual apathy in contemporary health care and calls for a rhetoric that will counter the jargon of cost analysis which currently prevails in the health services.

Curriculum↗
PubMed1997

Mental health nursing in the 1950s and 1960s revisited.

From the post-War period to the 1960s, immense changes took place in the philosophy, organization and delivery of mental health care in the UK. These changes were driven by the financial burden that Bevan's National Health Service imposed on the British Government, by the dynamism and vision of psychiatrists and mental health nurses returning from the War, and by a new social and cultural consciousness, which put minority groups such as the mentally ill onto the political agenda. This paper seeks to explore some of these complex interactions and to show how the closure of mental hospitals was the inevitable outcome of movements both inside psychiatry and far beyond it. An awareness of the historical context of mental health care can assist planners and providers to avoid the many pitfalls that have been made by our predecessors.

Ambulatory Care↗
PubMed1997

A critique of the concept of quality of life.

Taking a philosophical approach, ancient Greek philosophers and Christians began to investigate the concept of quality of life. Later, such philisophical pursuit was replaced by the school of positivism, which indicated that science was and still is the only valid form of enquiry. Through such positivistic science, the metaphysical nature of the concept of quality of life is thought to be uncovered. However, the later Wittgensteinian philosophical thoughts demonstrated that there is no metaphysical understanding of any concepts but there is only knowledge of playing language games. In the light of this philosophy, prior to any scientific investigations, researchers have already understood and agreed on the concept of quality of life by playing language games. From the above philosophical analyses, outlines some implications for health care research.

Health Services Research↗
PubMed1997

Post polio syndrome. The late sequelae of poliomyelitis.

Patients who in earlier life suffered from acute poliomyelitis are reporting new and disabling symptoms that have been variously labelled the 'late sequelae' or 'post polio syndrome'. Systematic review of such patients has identified specific categories of disability. A practical investigation and management plan for such patients presenting to a general practitioner is proposed.

Australia↗
PubMed1996

Science and early development of mental health nursing.

Until very recently, the history of mental health care received little critical investigation. This paper seeks to explore how the western scientific tradition shaped mental health nursing and investigates the pivotal influences which affected its early development, emphasising the role played by mid-19th century asylum care.

History, 18th Century↗
PubMed1996

Utilization of a personal health record in a general medicine clinic.

To determine the baseline use of personal medical records maintained by patients, to initiate utilization of a personal health record (PHR), and to assess outcomes associated with its use, a survey, intervention, and outcome study was conducted with follow-up at 2, 7, and 14 months. One hundred randomly selected adult patients of the General Medicine Clinic at The University of Iowa Hospitals and Clinics were evaluated. At onset, 44% maintained no records. At 14-month follow-up, 69% maintained the PHR. The change in documentation was statistically significant (p = .013 x 10(-8), McNemar's Test for Paired Data; 95% confidence interval 0.065, 0.54). The baseline use of personal medical records was poor, but it was improved following introduction of the PHR, and most patients continued using the record 14 months later.

Documentation↗
PubMed1996

Interaction, language and the "narrative turn" in psychotherapy and psychiatry.

The traditional emphasis in psychiatry about "listening to patients" has recently been added to by the development of what we call the "narrative turn" in mental health care where clients' narratives are emphasised. We shall argue however that both approaches tend to embody similar assumptions about therapeutic transactions and roles, and that much work emphasising narratives reveals little about how therapists and researchers work to reconstruct the clients' accounts. It is therefore vital that the emphasis on narratives be supplemented by a more thoroughgoing approach to shared structures of knowledge which act to prefigure clients' distress, how professional records are a profoundly transformative medium, and how therapeutic encounters work to co-construct clients' narratives, rather than simply reflect or explore them. The radical implications of thinking about therapy in terms of narrative and language need to be more fully discussed in the therapy literature, so the narrative turn does not simply reproduce the common-sense assumptions of more conventional approaches.

Communication↗
PubMed1996

Evaluation of health promotion activities in community nursing practice.

The purpose of this research was to study the extent to which community nurses (CNs) were involved in health promotion activities and to investigate whether these activities were meeting the needs of their clients. A cross-sectional survey by multiple methods was designed and carried out in four district health authorities (DHAs) in one regional health authority in England. Two hundred and fifty-one (83.67%) completed questionnaires were returned by CNs working in primary health care (PHC). Sixty sessions with CNs were observed and 249 interviews were conducted with clients. Additionally, as part of the observation 155 clinical records were examined. CNs reported involvement in a wide range of opportunistic and organized health promotion activities. Lifestyle advice and ill-health prevention were most frequently used by all groups. Health visitors (HVs) were involved significantly more in group and community wide activities. District nurses (DNs) were mainly involved in opportunistic health promotion. Practice nurses (PNs) were found to be involved significantly more in health promotion activities organized on an individual basis. Observation revealed that opportunistic health promotion was carried out in almost half of the consultations observed, of which lifestyle advice was the most frequent. Records however showed that this information was rarely recorded. The clients of PNs were mostly aware of other health promotion activities available within the general practice, while almost half of the HVs' clients knew what other health promotion activities were available to them and few DNs' clients were aware of any.

Adult↗
PubMed1996

Clinical features predictive of exercise-induced asthma in children.

Exercise-induced asthma (EIA) is a common symptom among young asthmatics. The hypothesis that asymptomatic day-to-day wide fluctuations in lung function and asymptomatic persistent airflow obstruction are risk factors for the development of EIA was studied. The study population was a cohort of known asthmatic children aged 9-14 years attending a residential asthma camp. The method involved the observation of baseline expiratory peak flow recordings (PEFR) for 5 days while the children were receiving their usual maintenance therapy. The method also included the determination of FEV1 pre- and post- 15 min of continuous aerobic exercise. Exercise-induced asthma was expressed as the Lability index (LI). The findings were that LI was significantly correlated (P < 0.01) with the mean PEFR as a per cent of each child's predicted PEFR. The lability index also correlated (P < 0.01) with the degree of day-to-day variability in PEFR expressed as the coefficient of variance (CV). It is concluded that there is a significant correlation between baseline asthma control and the development of EIA. In addition to recommending pre-exercise prophylaxis, practitioners should investigate overall asthma control in children reporting EIA.

Adolescent↗
PubMed1996

Chronic lymphatic leukaemia presenting as severe obstructive sleep apnoea.

A case of adenotonsillar enlargement from chronic lymphatic leukaemia leading to severe obstructive sleep apnoea (OSA) is described. Nasal continuous positive airway pressure (nCPAP) therapy was poorly tolerated because even at high pressures (+15 cm H2O) obstructive hypopnoeas persisted. Tonsillectomy resulted in significant improvement, though OSA persisted. nCPAP was reintroduced and at low pressures (+6 cm H2O) was efficacious in alleviating the patient's symptoms. This report highlights the need to consider OSA as a cause of constitutional symptoms in adults with lymphoreticular disease, especially where there is involvement of Waldeyer's ring.

Aged↗
PubMed1996

Development of a stress scale for mental health professionals.

This paper describes the development of the Mental Health Professionals Stress Scale (MHPSS): a self-report method of identifying sources of stress for mental health professionals. The 42-item scale, which includes seven subscales, was administered to 154 clinical psychologists and 111 mental health nurses. The MHPSS was found to have good internal consistency (alpha = .87 for clinical psychologists; alpha = .94 for mental health nurses). The preliminary evidence suggests that the concurrent validity of the MHPSS is good. The expected relationships between the scale and between the criterion measures--General Health Questionnaire, a symptom check list, job satisfaction, self-reported stress level and quality of social support--were demonstrated. The results also provide evidence for the discriminant validity of the subscales to measure different aspects of the stress experience. The MHPSS was shown to discriminate between two groups of health professionals who might be expected to differ in their sources of stress. For clinical psychologists the most important source of stress was 'professional self-doubt' whereas the major source of stress for mental health nurses was found to be the difficulty of handling potentially violent or difficult patients in the context of scarce staff resources. For both groups, however, 'home-work conflict' was the subscale most strongly and consistently associated with mental health outcome. It is concluded that the preliminary evidence regarding the utility of the MHPSS is encouraging, although further data are clearly needed.

Adult↗
PubMed1996

Effects of positive airway pressure on upper airway dilator muscle activity and ventilatory timing.

To determine upper airway (UA) and ventilatory responses to nasal continuous positive airway pressure (CPAP) and expiratory positive airway pressure (EPAP), we quantitated changes in alae nasi (AN) and genioglossus (GG) electromyographic (EMG) activity, ventilatory timing, and end-expiratory lung volume (EELV) at various levels of CPAP and EPAP in six normal subjects during wakefulness and in seven during sleep. The same measurements were also made before and after UA anesthesia in six normal subjects during wakefulness. During both wakefulness and sleep, CPAP application significantly increased EELV and decreased AN and GG EMG activities. In contrast, EPAP significantly increased EMG activities of both muscles while also increasing EELV during wakefulness. The EMG responses were less marked during sleep. Anesthesia of the UA abolished the EMG responses to CPAP but not to EPAP. These results suggest that, in normal subjects, CPAP application causes a reflex reduction in UA dilator muscle activity mediated by UA sensory receptors. In contrast, EPAP increases UA dilator muscle activity, with the response mediated by conscious influences or reflexes arising outside of the UA.

Adolescent↗