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Biomedical subjects

R Balogh

Publications and source records attributed to R Balogh.

16 recordsLinked to original sources
PubMed1998

A comparative analysis of six audit systems for mental health nursing.

PURPOSE: To devise an analytical framework to help identify strengths and weaknesses in the audit process as specified by existing psychiatric nursing audit systems, in order to analyse current audit practice and identify improvements for incorporation in the Newcastle Clinical Audit Toolkit for Mental Health. DATA SOURCES: Published material relating to the following six systems: the Central Nottinghamshire Psychiatric Nursing Audit; Psychiatric Nursing Monitor; Standards of Care and Practice; Achievable Standards of Care; Quartz; and Quest. DATA EXTRACTION: Comparison of the six systems according to an analytical framework derived from detailed empirical study (structures, processes and outcomes) of one of them in use and the educational evaluation literature. Examination of the extent to which guidance is provided for operating the systems and for wider process-related aspects of audit. RESULTS OF DATA SYNTHESIS: Five of the systems failed to specify some important elements of the audit process. Conceptually, the six systems can be divided into two main types: 'instrument-like' systems designed along psychometric lines and which emphasize the distance between the subjects of audit and the operators of the systems, and 'tool-like' systems which exploit opportunities for care setting staff to engage in the audit process. A third type of system is the locally-developed system which is offered to a wider audience but which does not make the same level of claim to universal applicability. CONCLUSION: The analytical framework allows different approaches to audit to be compared and contrasted not only according to the techniques used, but also according to process issues. The analysis of six systems revealed a variety of different techniques and procedures which can facilitate, in a methodologically rigorous manner, practitioner and other stakeholder involvement in audit processes.

Humans↗
PubMed1995

Effect of age on prehospital cardiac resuscitation outcome.

To compare resuscitation outcomes in elderly and younger prehospital cardiac arrest victims, we used a retrospective case series over 5 years in rural advanced life support (ALS) units and a University hospital base station. Participants included 563 adult field resuscitations. Excluded were patients with noncardiac etiologies, those less than 30 years old, and those with unknown initial rhythms. Patients were grouped by age. Return of spontaneous circulation (ROSC) and survival to hospital discharge were compared by Yates' chi-square test. ALS treatment of cardiac arrest was by regional protocols and on-line physician direction. Sixty percent (320/532) of patients were over 65 years old. The proportion with initial rhythm ventricular fibrillation (VF) was 50% in the elderly and 48% in younger patients. ROSC was achieved in 18% of elderly and 16% of younger patients; survival was 4% among the elderly and 5% for younger patients. The oldest survivor was 87 years old. Most survivors were discharged, in good Cerebral Performance Categories. There was no difference in outcome by age group when initial cardiac rhythm was considered. Early cardiopulmonary resuscitation (CPR) and ALS and initial rhythm VF were associated with the best resuscitation success. Age has less effect on resuscitation success than other well-known factors such as early CPR and ALS. Advanced age alone should probably not deter resuscitation attempts.

Adult↗
PubMed1995

Involving clients in clinical audits of mental health services.

Involving clients in service audits is never straightforward. In developing a new audit system for use in mental health settings a review of the literature demonstrated that the concept of satisfaction, like quality, is problematic because it is multidimensional, it is affected by expectations, and may be defined differently by professionals and clients. Furthermore, it fails to address the notion of empowerment. However, the literature provided some clear methodological guidance about involving clients in clinical audit. Clients must be involved in defining audit topics, and the most appropriate techniques of data-collection are open-ended and qualitative. Clients can also be involved in the process of audit, particularly through conducting audits in collaboration with professionals. Evidence from the literature persuaded the authors to abandon the idea of developing an audit module on patient satisfaction, and instead to develop one with a clear focus on clients' perspectives, entitled "Clients' Appraisal of Care" as part of the Newcastle Audit System, with clients involved throughout.

Data Collection↗
PubMed1993

Structure and regulated expression of angiotensin-converting enzyme and the receptor for angiotensin II.

The renin-angiotensin system maintains a homeostasis of blood pressure and blood volume. One component of this system is angiotensin-converting enzyme (ACE). There are two isozymes of ACE. The protein produced by vascular endothelium is termed "somatic ACE" and is regulated as a function of the growth state of these cells in vitro. The second isozyme, "testis ACE," is only produced by developing spermatozoa. The two ACE isozymes are the result of two distinct promoter regions within the ACE gene. Angiotensin II binds to specific receptors on the surface of cells. We have isolated cDNA encoding the AT1 subtype of receptor. This subtype is responsible for the hemodynamic consequences of angiotensin.

Animals↗
PubMed1993

Sperm-specific expression of angiotensin-converting enzyme (ACE) is mediated by a 91-base-pair promoter containing a CRE-like element.

The gene encoding the testis isozyme of angiotensin-converting enzyme (testis ACE) is one example of the many genes expressed uniquely during spermatogenesis. This protein is expressed by developing germ cells late in their development and results from the activation of a sperm-specific promoter that is located within intron 12 of the gene encoding the somatic isozyme of ACE. In vitro transcription, DNase footprinting, gel shift assays, and transgenic mouse studies have been used to define the minimal testes ACE promoter and to characterize DNA-protein interactions mediating germ cell-specific expression. These studies show that proper cell- and stage-specific expression of testis ACE requires only a small portion of the immediate upstream sequence extending to -91. A critical motif within this core promoter is a cyclic AMP-responsive element sequence that interacts with a testis-specific transactivating factor. Since this putative cyclic AMP-responsive element has been conserved within the testis ACE promoters of different species and is found at the same site in other genes that are expressed specifically in the testis, it may provide a common mechanism for the recognition of sperm-specific promoters.

Animals↗
PubMed1992

Tissue specific expression of angiotensin converting enzyme.

Angiotensin converting enzyme (ACE) is a component of the renin-angiotensin system and is critical in the homeostatic control of systemic blood pressure. There are two isozymes of ACE that result from two distinct promoter regions with the single ACE gene. In this article, we discuss the biochemistry of tissue specific promoter recognition as exemplified by the ACE gene.

Animals↗
PubMed1992

Audits of nursing care in Britain: a review and a critique of approaches to validating them.

The literature on audits of nursing care shows a strong link between the quality of nursing care and nursing labour force issues. Early attempts to develop a universally applicable formula to set nurse staffing levels on the basis of variations in patient dependency were shown to have been based on unrealistic assumptions about the ability of scientific methods to remove the influence of judgement from such areas of decision-making. The extent to which the validity of audit instruments has been established is reviewed, showing the number of studies to be small, almost exclusively in relation to American instruments, and with inconclusive results. An extension of the concept of validity is discussed, based on House's approach [House, E.R. (1980). Evaluating with Validity. Sage Publications, London, Beverly Hills] towards establishing validity in educational evaluation. This approach explicitly acknowledges the role of judgement in the evaluative enterprise, and widens the debate about how to settle questions of validity for audits of nursing care.

Clinical Protocols↗
PubMedDate not supplied

Off-the-shelf audit: is it feasible?

Increasing interest in audit in the health service has focused attention on the tools and methods used to achieve it. These can be extremely expensive, so a tendency to opt for off-the-shelf packages has developed. This article reviews how one such instrument, The Central Nottinghamshire Psychiatric Nursing Audit, has been used in two settings over the past three years, with particular emphasis on its cost-effectiveness.

England↗
PubMedDate not supplied

Defining quality in training institutions.

The views of nurse and midwife teachers occupy a crucial role in discussions about the quality of educational provision. So far, however, little information has been available on what the members of the profession think about this issue. In the course of a two-year research project commissioned by the ENB on performance indicators for training institutions, we asked teachers and their colleagues in all the English NHS regions to describe the characteristics of a high standard school. The study was conducted in the spring of 1988, that is, following the clinical grading review and the initiative to amalgamate school but before the NHS review and the acceptance of Project 2000. The data provided are an account of what is valued in schools of nursing and midwifery, for which a high degree of consensus was found among respondents. Management issues emerged as the top concern, followed by resources. Curriculum issues ranked third, closely followed by service links and professional/teacher issues. External links were of low importance.

Curriculum↗