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Biomedical subjects

S Davies

Publications and source records attributed to S Davies.

At least 199 records · Page 11Linked to original sources
PubMed1997

The effect of supplemental oxygen on the incidence of hypoxaemia after premedication in patients undergoing cardiac surgery.

Opiate premedication may cause significant respiratory depression, particularly when other sedative agents such as scopolamine or benzodiazepines are added. This can cause hypoxaemia with potential for worsening myocardial ischaemia in cardiac surgery patients. The aim of this study was to investigate the incidence of hypoxaemia (SpO2 < 90%) in elective patients undergoing cardiac surgery and to assess the efficacy of supplemental oxygen in preventing it. One hundred elective patients without significant respiratory disease or cardiac failure, who received both an opiate and a sedative premedication, were prospectively randomized to receive either oxygen via a facemask at 4 l/min or no oxygen. Continuous arterial oxygen saturation was recorded using a pulse oximeter from the time of premedication until the patient arrived in theatre. An SpO2 < 90% was recorded as a significant event and oxygen was administered to the patients. Six patients were excluded because of equipment failure or protocol violations. The patient groups were comparable with respect to patient demographics, premedication type and dose or the duration of monitoring. In patients receiving oxygen (n = 48) there were no episodes of hypoxaemia (0%). In patients not receiving oxygen (n = 46) there were 14 episodes of hypoxaemia (30%, P < 0.0001). We conclude that there is a significantly high incidence of hypoxaemia in cardiac surgery patients following combined opiate and sedative premedication and that it can be reduced by the routine administration of supplemental oxygen.

Analgesics, Opioid↗
PubMed1997

Long-term mortality after first psychiatric admission.

BACKGROUND: Little is known about the long-term mortality and causes of death after first psychiatric admission. METHOD: A consecutive series of 87 patients admitted for the first time from a strictly defined catchment area to Saxondale Hospital, Nottinghamshire, who were discharged in 1974 and 1975, were traced in 1992 to either their general practitioner or death. The causes of their deaths were ascertained and the observed mortality was compared with expected mortality. RESULTS: Twelve subjects had died. None had committed suicide, and there were no open verdicts or accidental deaths. Although the observed mortality was higher than expected, there was no significant excess. CONCLUSIONS: There may be little scope for reducing suicide rates by targeting patients for careful follow-up after discharge from their first psychiatric admission. More research is required before large investments are made in potentially fruitless interventions to achieve the objectives of The Health of the Nation.

Adolescent↗
PubMed1997

In-patient psychotherapy.

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Commitment of Persons with Psychiatric Disorders↗
PubMed1997

War pensions.

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Humans↗
PubMed1997

Ethnic differences in satisfaction with mental health services among representative people with psychosis in south London: PRiSM study 4.

BACKGROUND: Previous studies show that among Black Caribbeans there is a higher prevalence of schizophrenia and higher levels of both voluntary and compulsory admissions. These suggest that Black Caribbean patients may find psychiatric services less appropriate to their needs. The aim of this study was to establish the satisfaction with mental health services of representative psychosis patients in South London, especially in relation to ethnic group. METHOD: A random sample of all cases of psychotic disorder identified in the two sectors was interviewed using the Verona Service Satisfaction Schedule. Questionnaires from 50 Black Caribbean patients and 134 White patients were analysed. RESULTS: Black Caribbean patients, particularly those of second generation born in the UK, were significantly less satisfied with almost every aspect of the services that they received than either older Black Caribbean patients born in the Caribbean or White patients. Using multiple regression analysis it was found that among the younger Black Caribbean patients, unlike the other patients, the number of previous admissions was a significant predictor of dissatisfaction. CONCLUSION: Patients' ratings of satisfaction with mental health services are significantly worse for UK-born Black Caribbean than other patients with psychotic disorder in South London.

Adult↗
PubMed1997

Detection of methicillin-resistant Staphylococcus aureus: the evaluation of rapid agglutination methods.

The laboratory isolation of methicillin-resistant Staphylococcus aureus (MRSA) is now commonplace. Part of the screening procedure to detect MRSA rapidly is a reliable particle agglutination test for the presence of S. aureus. Forty clinical isolates of MRSA and 12 of coagulase-negative staphylococci were grown on the three culture media most likely to be used for the isolation of MRSA. Seven particle agglutination kits were evaluated for reliability. Their accuracy and speed of agglutination varied, with four kits, Staphaurex Plus, Pastorex Staph-plus, Slidex and Staphylase, giving better results with the isolates investigated.

Agglutination Tests↗
PubMed1997

Cytokine-primed bone marrow stem cells vs. peripheral blood stem cells for autologous transplantation: a randomized comparison of GM-CSF vs. G-CSF.

Autologous transplantation for non-Hodgkins lymphoma and Hodgkin's disease is widely used as standard therapy for those with high-risk or relapsed tumor. Peripheral blood stem cell (PBSC) collections have nearly completely replaced bone marrow stem cell (BMSC) harvests because of the perceived advantages of more rapid engraftment, less tumor contamination in the inoculum, and better survival after therapy. The advantage of PBSC, however, may derive from the hematopoietic stimulating cytokines used for PBSC mobilization. Therefore, we tested a randomized comparison of GM-CSF vs. G-CSF used to prime either BMSC or PBSC before collection for use in autologous transplantation. Sixty-two patients receiving transplants (31 PBSC; 31 BMSC) for non-Hodgkin's lymphoma (n = 51) or Hodgkin's disease (n = 11) were treated. All patients received 6 days of randomly assigned cytokine. Those with cellular marrow in morphologic remission underwent BMSC harvest, while those with hypocellular marrow or microscopic marrow tumor involvement had PBSC collected. Neutrophil recovery was similarly rapid in all groups (median 14 days; range 10-23 days), though two patients had delayed neutrophil recovery using GM-CSF primed PBSC (p = 0.01). Red cell and platelet recovery were significantly quicker after BMSC mobilized with GM-CSF or PBSC mobilized with G-CSF. This speedier hematologic recovery resulted in earlier hospital discharge as well. However, in multivariate analysis, neither the stem cell source nor randomly assigned G-CSF vs. GM-CSF was independently associated with earlier multilineage hematologic recovery or shorter hospital stay. Relapse-free survival was not independently affected by either the assigned stem cell source or the randomly assigned priming cytokine, though malignant relapse was more frequent in those assigned to PBSC (RR of relapse 3.15, p = 0.03). These data document that BMSC, when collected following cytokine priming, can yield a similarly rapid hematologic recovery and short hospital stay compared with cytokine-primed PBSC. Using primed BMSC, no difference in malignant relapse or relapse-free survival was observed. These findings suggest that despite widespread use of PBSC for transplantation, BMSC, when collected following hematopoietically stimulating cytokines, may remain a satisfactory source of stem cells for autologous transplantation. G-CSF and GM-CSF are both effective in priming autologous PBSC or BMSC for collection.

Adult↗
PubMed1996

Systemic lytic state is not a predictor of coronary reperfusion in acute myocardial infarction.

To investigate why approximately one third of patients thrombolysed with streptokinase fail to reperfuse, we assessed the lytic status, antistreptokinase antibody and non invasive parameters of reperfusion in 95 consecutive patients with acute myocardial infarction treated with streptokinase for the first time. The lytic status was assessed by Clauss fibrinogen assay and thrombin clotting time before and 2 h after streptokinase infusion. Antistreptokinase antibody was measured prior to the infusion. Reperfusion was assessed by measurement of the 24:96 h troponin-T ratio (a ratio > 1 indicating reperfusion) and ST segment resolution 2 h post streptokinase. Ninety-two (97%) patients achieved a systemic lytic state with a fibrinogen titre of less than 1.0 g/l and thrombin clotting time ratio of > 2.5. Despite this, 27% failed to reperfuse with a mean 24:96 h troponin-T of 0.9, SD 0.6 vs. 3.4 +/- 3.2 in the reperfused group, (P < 0.0001). 83% of the reperfused group but none of the non reperfused group had ST segment resolution. No difference was observed in the levels of fibrinogen and thrombin clotting time between the reperfused 0.25 +/- 0.3 g/l; 6.9 +/- 4, and the non reperfused group 0.4 +/- 0.6 g/l; 7.9 +/- 2.6. No difference was observed in the levels of antistreptokinase antibody between the reperfused (median = 168 U/ml and the non reperfused (median = 177 U/ml). Failure to reperfuse with Streptokinase is not due to failure to achieve a lytic state. Therefore increased or accelerated dosages of streptokinase are unlikely to increase the rate of reperfusion.

Antibodies↗
PubMed1996

Ethnic differences in risk of compulsory psychiatric admission among representative cases of psychosis in London.

OBJECTIVE: To compare the risk of detention under the Mental Health Act 1983 in a representative group of people with psychotic disorders from different ethnic groups. SETTING: Two defined geographical areas in south London. DESIGN: Annual period prevalent cases of psychosis were identified in 1993 in the study areas from hospital and community data. Standardised criteria were applied to case notes to establish diagnosis and detention under the act. SUBJECTS: 535 patients were identified, of whom 439 fulfilled ICD-10 criteria for psychosis. MAIN OUTCOME MEASURES: Risk of ever having been detained under the Mental Health Act 1983, risk of detention under specific sections of the act during the study year, and risk of contact with forensic services for the different ethnic groups. RESULTS: 439 patients with a psychotic illness were identified. Nearly half of the white patients had been detained under the act compared with 70% and 69% of black Caribbean and black African patients, respectively. Black Caribbean and black African patients were more likely than white patients to have been involuntarily detained (adjusted odds ratio 3.67; 95% confidence interval 2.07 to 6.50 and 2.88; 1.04 to 7.95, respectively). Rates of use of sections 2, 3 and 136 in the study year were higher for black than for white patients, and black patients were more likely than white patients to have been admitted to a psychiatric intensive care facility or prison. CONCLUSION: Independent of psychiatric diagnosis and sociodemographic differences, black African and black Caribbean patients with psychosis in south London were more likely than white patients to have ever been detained under the Mental Health Act 1983.

Africa↗
PubMed1996

Experiences of encouraging student-centred learning within a wellness-oriented curriculum.

This paper describes the use of learning logs as a tool for self-assessment and reflection during a 'well people' module within a Bachelor of Nursing programme. A qualitative analysis of the students' learning goals and reflective accounts from the learning logs are presented, together with extracts from the written evaluation of the module. Recommendations are made for enhancing the potential of the learning log as a flexible learning tool which can help students to draw upon professional knowledge in order to make sense of their experiences.

Curriculum↗
PubMed1996

How can nurse teachers be more effective in practice settings?

This paper reports on selected aspects of a research project commissioned by the English National Board for Nursing, Midwifery and Health Visiting (ENB) to investigate the relationship between teaching, support, supervision and role modelling in clinical areas, within the context of Project 2000 diploma courses. The paper will focus upon findings which related to the role of the nurse teacher in practice settings. These were derived from interviews with students, practitioners and nurse teachers in three Project 2000 centres in England, and from a series of case studies in practice settings providing learning experiences for students undertaking the adult and mental health branches of Project 2000 diploma courses. Findings are discussed in relation to four broad areas: establishing a role for nurse teachers within the practice team; preparation of practitioners for their role in student learning; helping students to link theory and practice; and the nurse teacher's role in developing practice.

Adult↗
PubMed1996

Basophil counts on the technicon H*1 automated counter.

The precision, accuracy, stability and clinical usefulness of the basophil count of a Technicon H*1 automated blood cell counter were assessed and a reference range for the absolute basophil count was derived. As expected, the precision was considerably better than that of a manual count but it was worse than would have been expected if the only inaccuracy were the random error consequent on the number of cells counted. Accuracy was sufficient for the count to be of some clinical use but an elevated 'basophil' count was more often consequent on 'pseudo-basophilia' than on true basophilia. As a consequence it is necessary to confirm elevated counts by microscopic examination of a blood film whenever the presence of an elevated count is diagnostically important. The basophil count was stable for up to 3 days, both at room temperature and at 4 degrees C. The reference range was 0.02-0.09 x 10(9)/I. An elevated 'basophil' count serves to alert the instrument operator to the presence of an abnormal blood sample. Since the technology used to count basophils is the same in H*1, H*2 and H*3 instruments, our results can be generalized to other instruments in the series.

Basophils↗
PubMed1996

The supervision of Project 2000 students in the clinical setting: issues and implications for practitioners.

The aim of this 2-year study funded by the English National Board for Nursing, Midwifery and Health Visiting was to examine the relationship between teaching, support, supervision and role modelling in student clinical learning within the context of Project 2000 courses. The research, using a two-stage case-study design, employing predominantly qualitative methods of data collection, investigated the perceptions of students, tutors and practitioners of their experiences of these processes in the clinical setting. This paper focuses on the findings obtained from the practitioner data, high-lighting not only the significant role played by practitioners in facilitating student learning, but also the implications for practitioners in undertaking this role. The preparation required for supervising clinical learning, the integration of theory and practice and the organization of patient care have been identified as particularly important to the development of effective clinical learning environments.

Clinical Competence↗
PubMed1996

Psychological adjustment and family functioning in a group of British children with sickle cell disease: preliminary empirical findings and a meta-analysis.

Sickle cell disease (SCD) is a family of inherited blood disorders of variable severity which have in common haemolytic anaemia, recurrent painful crises, end-organ failure and the risk of reduced life expectancy. In Britain, the condition predominantly occurs among families of African or Afro-Caribbean origin. This study examines the effects of the condition on the psychological adjustment and family functioning of 39 children with SCD and 24 control children. Participants were assessed on measures of behaviour, depression, self-esteem, IQ and reading skills, family relationships and maternal mental health. Assessment on the Family Environment Scale showed that SCD children came from families who reported more cohesion and less conflict than did the families of controls. Maternal mental health showed no significant differences between the SCD group and controls. Children with SCD showed an IQ deficit of five points, a difference that was not statistically significant. However, a meta-analysis of six studies in the literature, including this one, did show a highly significantly decreased intellectual ability. SCD children did not show significant differences from controls on measures of depression and self-esteem. However, differences in behavioural problems were found between the three groups, with the SC group showing more behavioural problems. Results of regression analyses suggest that maternal mental health is associated with children's behavioural problems.

Adaptation, Psychological↗