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Biomedical subjects

R Newell

Publications and source records attributed to R Newell.

33 records · Page 2Linked to original sources

The extent of parental compliance with timing of administration of their children's antibiotics.

Antibiotics are widely prescribed to children, and the responsibility for ensuring adequate administration typically rests with parents. However, compliance with antibiotic medication is generally low, and previous studies often fail to specify the criteria for compliance adequately. In particular, little attention has been paid to accuracy of timing of antibiotic administration outside hospital, even though timing is important in maintaining therapeutic drug levels. The current study examined the self-reports of 75 mothers of their behaviours in administration of antibiotics to their children, with particular attention being paid to the frequency and timing of administration. The study found that, when timing of doses was considered, only seven parents could be considered as fully compliant with dosage instructions, a much lower proportion than indicated in previous studies which applied a more lenient definition of compliance. The implications of this finding are discussed, with particular reference to the role of the nurse and to the comparative usefulness of different definitions of compliance.

Adult↗

Anxiety, accuracy and reflection: the limits of professional development.

Reflection is a key concept in the development and maintenance of nursing expertise in theory and practice, yet commentators have rarely examined difficulties associated with it. This paper describes the role of reflection in nursing and relates it to information-processing accounts of human memory. The issues raised by the role of memory in mediating reflection are discussed, in the context of an examination of the importance of accuracy in reflection-on-practice. It is argued that anxiety is of particular importance in mediating accurate reflection. Whilst it is concluded that reflection is inherently flawed, a range of tactics to enhance it are explored, with particular emphasis on anxiety reduction and reduction of the burden of the memory task.

Anxiety↗

The single case experimental design: a quantitative method for everyday use.

Although the qualitative approach to research has become a dominant trend in nursing research, some commentators have argued the strengths of quantitative methods, particularly if the data are sensitively handled by investigators (1). This article argues for greater use in nursing research of a particular quantitative method: the single case experimental design. It traces the development of the methodology, describes the designs of which it consists and their associated statistical handling, and examines the relevance of the approach as a whole to nursing, particularly during the construction and testing of innovative approaches to client difficulties. The paper concludes by suggesting the potential impact of the adoption of single case methods for nursing practice and research.

Clinical Nursing Research↗

Behavioural psychotherapy in the treatment of irritable bowel syndrome.

The irritable bowel syndrome is a highly prevalent condition whose underlying aetiology is not understood. While many patients respond to a combination of gastrointestinal antispasmodics, bulking agents and dietary manipulation, controlled clinical trials have suggested that the benefit is only marginal and is due mainly to the large placebo effect found in this condition, which has been calculated to range between 54 and 81%. Associations between the syndrome and psychological and social stresses suggest, however, that treatment involving a systematic approach to the management of symptoms may hold out real therapeutic possibilities. In the current study, 42 IBS patients were randomly allocated to either medical treatment or to behavioural psychotherapy with a nurse therapist. They were assessed initially and at 4 and 9 months. There was a general improvement over the 9 months on a number of physical and psychological symptoms measured. However, no differences were found between treatment groups except for changes in two avoidance scores. A significant correlation was found, however, between improvement in the bowel symptoms of IBS (stomach pain and diarrhoea) and improvement in the psychological symptoms measured by the Clinical Interview Schedule, suggesting a close interrelationship between the two.

Adult↗

Body-image disturbance: cognitive behavioural formulation and intervention.

An account of the genesis and maintenance of disturbed body image is presented, drawing on cognitive-behavioural concepts of human experience, and emphasizing the central importance of fear and avoidance in mediating such difficulties. Intervention strategies, extrapolated from work in dysmorphophobia and in anxiety disorders, are described, together with a clinical example. Difficulties with the cognitive-behavioural approach to disturbed body image are discussed, and possible applications of the formulation to client care are suggested.

Adult↗

Continuous intracranial pressure monitoring and serial electroencephalographic recordings in severely asphyxiated term neonates.

We report our observations from intensive intracranial pressure (ICP) monitoring and serial clinical neurologic and electroencephalographic examinations in ten asphyxiated full-term neonates, of whom five died and at least two survivors had multiple severe neurologic handicaps. Direct measurements of ICP were obtained by a newly developed infant subarachnoid bolt and/or a transfontanelle pressure transducer. Simultaneous ICPs were recorded and correlated when possible. We noted a dependence of transfontanelle ICP values on application technique and force. In infants with no bleeding diathesis, the subarachnoid bolt was safe and no complications were encountered. Only six infants experienced pathologic elevations of ICP following birth asphyxia, and of these infants only two had sustained, marked increases of ICP. We also noted abundant fluctuations of cerebral perfusion pressure (mean arterial blood pressure minus ICP), but the majority of fluctuations were accounted for by mean arterial pressure changes rather than ICP changes. We found no deterioration of clinical neurologic function as measured by serial mental status examinations and electroencephalogram samples at the time the maximum ICP was measured. We also noted very little change in ICP during most electrographic seizures. In these infants ICP did increase after birth but major ICP elevations were uncommon and did not appear to introduce any acute functional neurologic disturbances. Most changes in cerebral perfusion pressure were attributed to blood pressure rather than ICP changes. It appears unlikely that cerebral edema and elevated ICP play a major role in determining neurologic outcome in some asphyxiated term infants.

Asphyxia Neonatorum↗

A pedigree study of perinatally lethal renal disease.

A family study of perinatally lethal renal disease (PLRD) was undertaken in the State of Victoria, Australia, for the years 1961 to 1980. A total of 221 cases was ascertained through hospital and necropsy records and confirmed by necropsy findings. There were 134 cases of bilateral renal agenesis (BRA), 34 cases of unilateral agenesis with dysplasia of the other kidney (URA/RD), 42 cases of bilateral renal dysplasia (BRD), and 11 cases of renal aplasia. Parents of 131 babies were interviewed and 153 parents from 82 families had a renal ultrasound examination. In the period of best ascertainment (1975 to 1980) the frequency of PLRD was 0.27 per 1000 and of BRA 0.16 per 1000. There were 10 cases of sirenomelia, a frequency of 0.008 per 1000. For all families of PLRD, 15 of 423 (3.6%) sibs and three of 1579 (0.2%) first cousins were affected. One family had three sibs with BRA and four had two sibs with BRA. One pair of sibs and two first cousins had BRA in one and URA/RD in the other affected. One baby had BRD with an affected first cousin. The nature of the renal lesion was not established. When the index case had BRA, 14 in 283 (5.6%) sibs had PLRD. Where the index case had BRA and urogenital defects, but no birth defects in other organs, 12 of 148 sibs (8%) were affected. None of the sibs had BRA when the index case had BRA as part of a multiple malformation complex. In the multiple malformation group, however, five of 40 (12.5%) sibs had similar patterns of malformations. Renal ultrasound abnormalities were no more frequent in parents of two affected babies (one of 18) than in the other parents (nine of 135). Our findings confirm that BRA and URA are genetically related. There are a number of conclusions which are important for genetic counselling. There is a high likelihood of recurrence (8%) in sibs when the index case has BRA and urogenital abnormalities alone. When BRA is part of a multiple malformation complex, the risk of recurrence of multiple malformations is significant (12.5%), but risk recurrence of BRA is low. The finding of renal ultrasound abnormalities in the parents was not informative.

Abnormalities, Multiple↗

Comparison of modified A-1 method with standard EC test for recovery of fecal coliform bacteria for shellfish.

This study is one of a series in which variations of the A-1 method for the detection and enumeration of fecal coliforms and Escherichia coli in seawater and foods were evaluated. The tests were conducted jointly by the Food and Drug Administration and state and provincial laboratories that support shellfish control programs in the United States and Canada as part of the National Shellfish Sanitation Program's Microbiology Task Force activities. Results showed significantly higher recovery of fecal coliforms from naturally contaminated shellfish by the AOAC official A-1-M method than by the American Public Health Association standard method. There was no significant difference in recovery of E. coli by the 2 methods.

Animals↗

Commercial cryptococcal latex kit: clinical evaluation in a medical center hospital.

A commercial latex kit for the detection of cryptococcal antigen (LCAT) was used in a medical center hospital to test cerebrospinal fluid (CSF) and serum specimens from patients suspected of having cryptococcal infections. The LCAT was also performed on 8 CSF and 2 serum specimens from other mycotic infections and on 50 serum specimens from healthy controls. Of a total of 561 specimens (489 CSF and 72 sera) from 426 patients, 78 (13.9%) specimens were LCAT positive; these came from 12 patients with culturally proven cryptococcosis. Eleven of these 12 patients were diagnosed as having disseminated cryptococcosis (9 with meningitis). Fourteen other patients, all with positive cultures for Cryptococcus neoformans but nevative LCATs on sera or CSF, were found not to have disseminated infections. All CSF and sera from other mycotic infections and all 50 control sera were negative. No false positive or flase negative tests were encountered. It was concluded that the commercial kit is useful for diagnosis and prognosis of disseminated cryptococcosis, but not as useful for infections such as localized pulmonary or cutaneous cryptococcosis.

Antigens, Fungal↗

Challenging behaviour in children with learning disabilities.

This article outlines the initial stages of an ongoing experiment to evaluate the comparative efficacy of two different therapeutic interventions--behaviour modification and gentle teaching--in the management of challenging behaviour in children who have learning disabilities. Using a workshop approach, parents are taught the principles and practice of one of these two interventions to enable better management of their child's challenging behaviour. A range of intervention outcomes are then compared with those of a control group. Preliminary analysis of data has been conducted on information gathered from those parents (n = 24) who attended the gentle teaching workshop only. The results indicate that brief intervention training in gentle teaching can have a positive impact upon the challenging behaviour of the child.

Adolescent↗