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Biomedical subjects

S M Gallagher

Publications and source records attributed to S M Gallagher.

49 records · Page 3Linked to original sources

A discussion of futility and chronic wound care.

Although futility is commonly referred to when discussing end-of-life issues, theories of futile care are applied to issues of chronic care, particularly chronic wound care, herein. A case study will be used within the context of defining futility, understanding beneficence in healthcare, and discussing the obligation of the clinician to deliver therapeutic intervention that balances burden with benefit. Open and honest communication will be highlighted as one method to facilitate resolution when dilemmas of futility occur.

Ethics, Nursing↗

Cultural influences on medical disclosure.

Personal freedom and individualism are highly valued in Anglo-American culture and consequently in healthcare. However, not all cultures recognize the value of these principles. Healthcare can be compromised when the patient's cultural context differs from that of the clinician. Culture and its influences on the disclosure of health-related information are described. Self-determination from an historical perspective, the role of the family, and a deeper understanding of paternalism as they relate to cultural issues are illustrated through a case study. Suggestions for creating a culturally relevant healthcare practice is presented.

Attitude to Health↗

Maintaining confidentiality and privacy in case study presentations: implications for wound care education.

Wound care professionals are often called upon to prepare others to care for patients with chronic and other forms of skin injury. Case presentations offer a creative and meaningful approach in teaching assessment and treatment options. However, case presentations pose threats to patient confidentiality and privacy. Using a clinical situation, confidentiality and privacy issues that can arise from these case presentations are briefly described and recommendations are provided to enable clinicians to avoid situations that violate the patient's privacy.

Confidentiality↗

The ethics of teamwork.

Some tasks are better accomplished by a successful team effort. Teams do not replace individual achievement; however, some ethical dilemmas cannot be resolved by individuals. Teams and teamwork are defined within the context of a case study. Types of teams, factors that strengthen teams, and circumstances that threaten teams are presented.

Communication↗

Ethical dilemmas in pain management.

Pain management is becoming an increasingly important component of comprehensive wound care. Choices for the best approach in managing the elderly patient with painful wounds can pose ethical dilemmas. Ethical principles such as autonomy, beneficence, and non-maleficence are explored through a case presentation. Suggestions for addressing these ethical dilemmas are examined.

Aged↗

Truth telling.

Truth telling is considered a respected and honored tradition in American culture. This paper discusses truth telling within the context of healthcare, including the duty to tell the truth, the nature of truth telling, and common practices for avoiding the truth. Ethical considerations are reviewed within the context of truth telling, and a case study is presented.

Adult↗

Powerlessness as a factor in health defeating behavior.

Lack of compliance in prevention and treatment of illness and disease continues to perplex healthcare practitioners. Sixty percent of patients take their medications incorrectly. Patients miss appointments, they do not follow up with treatments, and many times require an avoidable hospitalization directly related to health defeating behaviours. Many healthcare clinicians believe the reason for this could be issues such as basic intellectual level, convenience, cost, side effects, or one's value system. However, these may not be the only factors in lack of compliance. The purpose of this paper is to discuss powerlessness as a factor in health defeating behaviors. Powerlessness as a Third World behavior will be described in detail along with methods to identify these behavioral patterns. Paternalism will be described as a threat to Third World groups and their healthcare. An increased awareness and sensitivity to the needs of this special group may improve health promoting behaviors. The LEARN Model will be discussed as a framework for empowering otherwise powerless individuals and groups through improved communication and understanding.

Communication↗

Morbid obesity: a chronic disease with an impact on wounds and related problems.

Morbid obesity is a chronic disease that manifests as a steady, slow, progressive increase in body weight. Because of both emotional and physical reasons, obese people resist pursuing healthcare and may be more difficult to care for. In taking a practical approach to skin and wound care, using an interdisciplinary team is valuable. Difficulty in assessment stems from problems such as equipment that is too small or as patient uncooperativeness. Skin/wound problems which are common, yet more difficult to manage for these patients, include pressure ulcers, tracheostomy care (potentially resulting from ventilatory insufficiency), candidiasis, tape-related skin tears, incontinence and lymphedema. In order to offer care and support to these patients and their families, clinicians must acknowledge and manage any personal prejudice they may have toward this patient population. A comprehensive patient-focused plan of care is the goal. With this article are included four annotated suggested readings introducing topics such as the failure of behavioral and dietary treatments for obesity, theoretical and practical aspects of obesity assessment, current views on obesity (such as a move back to pharmacotherapeutic treatment), and the psychological aspects of severe obesity.

Chronic Disease↗

Promoting the nurse practitioner by using a marketing approach.

Being good at what you do is not enough. Despite strong evidence that the nurse practitioner delivers cost-efficient and outcome-based care, few consumers really understand the nurse practitioner's scope of practice. With the current rapidly changing status of health care, the nurse practitioner is presented with many opportunities. Strategies that ensure survival and growth are critical to longevity. Marketing strategies can offer solutions to these challenges. The 4 P's of marketing are discussed as an approach to promote the role of the nurse practitioner.

Advertising↗

Acupuncture therapy for the treatment of intractable, idiopathic epilepsy in five dogs.

Five epileptic dogs, nonresponsive to high levels of anticonvulsants were presented to the acupuncture clinic at the Veterinary Hospital of the University of Pennsylvania for treatment. Acupuncture was performed by placing small gold implants subcutaneously over the calvaria at acupuncture points on the Governing Vessel (GV), Gall Bladder (GB), and Bladder (B) meridians and left in place to provide constant stimulation to the points. Each of the five dogs treated showed a change in seizure patterns following gold implant placement. Two dogs had decreases in seizure frequency with their medication continued as before acupuncture, but they reverted to their previous pattern approximately five months after treatment. Three dogs continued to have decreased numbers of seizures and were maintained on decreased levels of anticonvulsants.

Acupuncture Therapy↗

Ultrastructural observations on the effect of 4-hydroxyanisole on normal human melanocytes in tissue culture.

Riley's classic 1970 experiment showing a specific cytotoxic effect of 4-hydroxyanisole (4-OHA) on tissue-cultured melanocytes of black guinea pig ear skin was repeated on normal human melanocytes, and the results were examined by electron microscopy. In dispersed tissue culture, no specific toxic effect on human melanocytes was observed following equally timed exposures to similar (10(-3) M) or even higher (10(-2) M) concentrations of the drug; plasma membrane, nucleus, and cytoplasmic organelles, including melanosomes were unaffected. The same applied to melanocytes of whole epidermis exposed for 5 hr to the same concentrations of 4-OHA in culture medium. Melanocytes of PUVA treated skin similarly exposed for up to 24 hr to 10(-2) and 10(-3) M 4-OHA, likewise exhibited no evident morphological damage at the ultrastructural level. The discrepancy of results between guinea pig and man could have a variety of explanations, one of which could be due to a possible relatively low level of active tyrosinase in the human melanocytes (Riley believes the cytotoxic effect of 4-OHA to be due to the fact that it acts as a substrate for tyrosinase, toxic intermediates being liberated as a result). However, the lack of effect on the PUVA-activated melanocytes indicates that this cannot be the entire explanation.

Anisoles↗

The critical care nurse practitioner: an advanced practice role for the critical care nurse.

Research provides compelling evidence that supports the current and future utilization of critical care nurse practitioners (CCNPs) in pivotal roles as providers of cost-effective, quality patient-centered care for critically ill and technology-dependent adults. This paper gives a historical perspective and describes the current national need for CCNPs to practice in expanded roles both within and outside the boundaries of intensive care. An existing CCNP program is described. In addition, guidelines for CCNP program development and role implementation are discussed.

Adult↗

Outcomes in clinical practice: pressure ulcer prevalence and incidence studies.

Payors and providers are seeking strategies to reduce the number and severity of pressure ulcers, while consumer groups are demanding reporting systems that reflect the success of such strategies. Prevalence and incidence studies are a quality assurance method of monitoring the success of pressure ulcer prevention and treatment in an acute care setting. Outcomes-based practice can be a result of Continuous Quality Improvement, of which benchmarking is a powerful tool. Outcomes can be identified through epidemiologic studies and prevalence and incidence studies. To measure outcomes, it is important to consider the various members of the study team, choose an appropriate time between the prevalence and incidence studies, and design consistent methods of data collection. The goal is to be able to analyze the data in such a manner that it can be compared to data collected in other studies. Success in managing the identified and measured outcomes lies in being able to pinpoint trends, track outcomes over time, and share and compare the resulting information. Quality improvement activities are an avenue for all patient care providers to blend theory, practical experience, and research principles into more fiscally-responsible, quality-based care.

Data Collection↗