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Biomedical subjects

S Oliver

Publications and source records attributed to S Oliver.

At least 73 records · Page 4Linked to original sources
PubMed1994

A comparison of two quality assessment instruments: Monitor and Senior Monitor.

Similarities and differences between the two U.K. generic quality assessment instruments, Monitor and Senior Monitor, are outlined. The relative merits of each are explored to determine the most valid instrument for assessing the quality of care of elderly patients. Both instruments were simultaneously administered to 46 patients aged 70 years or over in three medical, three surgical and three elderly care wards. Senior Monitor scores were significantly lower than Monitor scores for the nine wards overall. This remained the case when the sections in Senior Monitor that do not feature in Monitor were removed from the analysis. Factors to be taken into account when selecting which instrument to use with elderly patients are outlined.

Aged↗
PubMed1994

Evaluation of Kitson's therapeutic nursing function matrix in the assessment of quality of nursing care in hospital.

This paper describes our test of Kitson's structured observation and scoring technique (the Therapeutic Nursing Function Matrix--TNFM) and our development of her technique (referred to as the Quality Assessment Project scheme--QAP scheme) as methods of assessing the quality of patient care in hospital wards. Both techniques were tested for inter-observer reliability and for validity against continuous observation. Kitson's technique and the QAP scheme reached acceptable levels of inter-observer agreement for identification of patients' activities, but not for scoring of those activities. Overall, the QAP scheme was found to be more reliable than the Kitson technique. Validity testing against continuous observation again revealed acceptable levels of inter-observer agreement for identification of activities, but not for scoring of those activities. For the Kitson technique there was virtually no agreement in scoring between observers. The QAP scheme achieved higher agreement but needs further work to iron out problems of detail. The conclusion reached is that the QAP scheme is a promising method for assessing the quality of nursing care in hospital wards.

Activities of Daily Living↗
PubMed1994

Ventricular septal defects. A case study and discussion.

Ventricular septal rupture is a serious complication of acute myocardial infarction (MI) that generally produces progressive circulatory failure and rapid deterioration. Prompt diagnosis followed by surgical repair with peri-operative circulatory support is often life-saving (Mazeika et al 1994). The following is an account of a patient that I cared for, whilst working on the coronary care unit (CCU) as part of an ENB 125 course. The patient was originally admitted with an inferior MI and went on to develop a ventricular septal defect (VSD).

Coronary Care Units↗
PubMed1994

Sublingual nifedipine: the continuing controversy.

Sublingual, as opposed to oral, administration of Nifedipine (Adalat) has gained wide popularity as the method of choice when the most rapid onset of anti-hypertensive action is required. However recent research indicates that this delivery method may be without scientific validation, and may in fact delay the attainment of peak plasma concentrations of the drug. Peak Nifedipine serum concentrations have been shown to be less following sublingual administration than following oral administration, and the time to peak concentration has been shown to be longer following sublingual administration than with the oral dose. The lack of a standardised technique for the administration of sublingual Nifedipine means that in many cases the patient may be receiving sub-therapeutic doses of the drug.

Administration, Oral↗
PubMed1994

The value of prostatic specific antigen in prostate cancer screening in the community.

At a one-day screening for prostate cancer in 1991, a urologist evaluated 142 men ages 50 years-84 years (mean: 67 years) utilizing a digital rectal exam (DRE), serum prostatic specific antigen (PSA), and a detailed questionnaire. The 44 men with an abnormal DRE and/or PSA were recontacted by letter one year later to determine the outcome. By 12 months, 31 men (70%) with abnormal findings had seen a physician as recommended. Of the 13 men followed with abnormal DRE only, three were biopsied with no cancer found. Of the 11 with an elevated PSA only, six were biopsied and two had cancer. Of the men with both abnormal PSA and DRE, six were biopsied and two had cancer. Thus, after 12 months, the preliminary cancer detection rate was 2.8% for the entire study population, 22% for those with an elevated PSA, and 10% for those with an abnormal DRE. The results suggest that the use of PSA combined with DRE is a more efficient strategy for detecting prostate cancer than DRE alone.

Adenocarcinoma↗
PubMed1993

Immunocytochemical localization of c-erbB-2 protein in transitional cell carcinoma of the urinary bladder.

The level of expression and cellular localization of the c-erbB-2 gene product in transitional cell carcinoma of the urinary tract is controversial. Analysis of the c-erbB-2 gene structure and comparison of its expression in the same cells by Southern, Northern and immunoblotting, and by immunocytochemistry minimize the errors of interpretation inherent in one technique. Such a 'correlative study' has been performed on tumours from 82 patients. c-erbB-2 gene amplification was detected in 14 per cent of initial tumours and was associated with grade (P < 0.001). Raised levels of mRNA were seen in those tumours with increased gene copy number and in 13 per cent of the remainder. Immunoblotting detected the expected 185 kD immunoreactive protein and a 155 kD protein associated with high gene copy number. Immunocytochemistry localized c-erbB-2 immunoreactivity to the cell membrane and cytoplasm, and the latter predominated. Four antibodies to c-erbB-2 (AB-3, 21N, pAb 1, and NCL CB11) were compared on contiguous sections of the same tumour and showed the same pattern of immunoreactivity. Similarly, analyses carried out in three independent laboratories identified the same cellular localization. Membrane and cytoplasmic immunoreactivity was demonstrated in all tumours with gene amplification or increased mRNA levels and in 40 per cent of the remaining tumours. We showed that immunocytochemistry requires careful standardization of techniques and quantitation between different groups. However, despite variations in the intensity of immunoreactivity, the total number of positive cells remained constant. Therefore quantitation must be based on the number of positive cells and, ideally, their immunoreactive content relative to normal and positive tissue controls.

Biomarkers, Tumor↗
PubMed1993

Inter-rater reliability of Monitor, Senior Monitor and Qualpacs.

This paper describes inter-rater reliability of three quality assessment instruments: Monitor, Senior Monitor and Qualpacs. The work forms part of a Department of Health funded study examining the reliability and validity of these three instruments. Inter-rater reliability is not a fixed entity and therefore should be tested every time raters or the setting change. In this instance, testing was carried out in three wards (one elderly and two surgical). Two methods of analysis were used: percent agreement and intra-class correlation coefficient. Results and some of the techniques that were found to be useful in enhancing reliability are described. Acceptable levels of inter-rater reliability with all three instruments were reached.

Geriatric Nursing↗
PubMed1993

Inoculation of peritoneal dialysate fluid into blood culture bottles improves culture rates.

The aim of the study was to determine if direct inoculation of peritoneal fluid into Bactec blood culture bottles would improve the positive bacteriological yield compared with conventional techniques in continuous ambulatory peritoneal dialysis (CAPD) patients with peritonitis. All patients presenting with suspected peritonitis had peritoneal fluid injected directly into aerobic and anaerobic Bactec blood culture bottles as well as into sterile culture tubes. Thirty-seven paired samples were analysed. Twenty conventional cultures (54%) were positive compared with 33 (89%) done according to the Bactec system (P < 0.002). In only 1 case did the former technique prove superior. Direct inoculation of peritoneal fluid into Bactec blood culture bottles is therefore superior to conventional methods and has obvious therapeutic implications.

Ascitic Fluid↗
PubMed1992

Fluorocytosine causes uncoupled dissipation of the proton gradient and behaves as an imperfect substrate of the yeast cytosine permease.

At pH 5-6 ATP-depleted washed cell preparations of strain NC233-10b[pII4-9], in which the cytosine permease was overexpressed, absorbed cytosine, hypoxanthine or fluorocytosine stoichiometrically with, respectively, about 1, 1.4 and 5 proton equivalents. The cellular pH fell proportionately. The membrane depolarization caused by each compound was assayed in the presence of glucose with a voltage-sensitive dye and increased in the same order. Fluorocytosine significantly lowered the growth yield that a 'petite' strain of the yeast formed at limiting glucose concentrations. At pH 5.6 with extracellular [K+] below 1 mM, each of the three substrates was accumulated about 200-fold from a dilute solution at the expense of the proton gradient. This concentration ratio corresponds to a solute gradient (delta mu(s)) of 13 kJ mol-1. Raising [K+]o systematically lowered the substrate accumulation ratio and delta muH. The mean ratio delta mu(s)/delta muH was 0.82 for all three substrates. It was concluded that whereas the behaviour of cytosine approximated to that expected for a symport of unit proton stoichiometry, the absorption of protons with fluorocytosine and, to a lesser extent, hypoxanthine, was only partly conserved as useful work. A possible mechanism of this novel phenomenon is outlined.

Adenosine Triphosphate↗
PubMed1992

Efficacy of normal saline injection with and without heparin for maintaining intermittent intravenous site.

This study evaluated the effectiveness of normal saline versus normal saline containing 10 U per 1 mL heparin for preventing loss of an intermittent intravenous site (heparin lock). The sample consisted of 260 surgical patients from a general surgery and a cardiovascular surgery nursing unit at a tertiary care hospital. Results indicated that heparinized saline is not needed to maintain the patency of an intermittent intravenous site, and the use of saline solution alone is less irritating, causes less phlebitis, is less expensive to patients, and saves nursing time.

Female↗
PubMed1992

Developing Flanagan's critical incident technique to elicit indicators of high and low quality nursing care from patients and their nurses.

This paper discusses a development of Flanagan's critical incident technique (CIT) to elicit indicators of high and low quality nursing from patients and their nurses on medical, surgical and elderly care wards. Stages in undertaking the CIT are identified and presuppositions held by most researchers about the nature of the technique are identified. The paper describes how the authors moved to a different set of presuppositions during the course of the study. Preliminary analysis of interview transcripts revealed that critical incidents need not always be demarcated scenes with a clear beginning and end, but may arise from respondents summarizing their overall experience within their description of one incident. Characteristically respondents were unable to give a detailed account of such incidents but validity may be established by the fact that respondents appear to recount what actually happened as they saw it, and what they said was clearly important to them. The researchers found that the most appropriate basic unit of analysis was not the incident itself but 'happenings' revealed by incidents that are 'critical' by virtue of being important to respondents with respect to the quality of nursing care. The importance of CIT researchers achieving an understanding of the 'meaning' of critical happenings to respondents is emphasized. Analysis of the interview transcripts is facilitated by the use of INGRES, a relational database computer program which should enable a 'personal theory' of quality nursing for each respondent, both patients and nurses, to be described. The study suggests that the CIT is a flexible technique which may be adapted to meet the demands of nursing research. If carefully applied, the CIT seems capable of capitalizing on respondents' own stories and avoids the loss of information which occurs when complex narratives are reduced to simple descriptive categories. Patients and nurses have unique perspectives on nursing and their views are of primary importance in understanding what quality means with respect to the interpersonal processes that are integral to nursing care. This paper discusses the identification of indicators of quality nursing from interviews with patients and nurses using the authors' development of Flanagan's critical incident technique.

Data Collection↗
PubMed1992

Eating in the adult world: the rise of dieting in childhood and adolescence.

Dieting is a common practice among adolescent girls. Recent research suggests that adolescent dieting may not be benign and that it is becoming more frequent in younger age groups. The present study investigated dieting motivation and the underlying attitudes to body weight and shape in two age groups. Eighty-four nine-year-old and 86 14-year-old girls from the same school completed assessments of dietary restraint, body esteem, body satisfaction and body figure preferences. The girls' body weight and height were also measured. The distribution of restraint scores revealed individuals from both age groups in every category of dieting motivation. Subjects in the upper and lower quartiles of the restraint distribution were identified and compared on the other measures. The highly restrained girls expressed low body esteem and discontent with their body build, weight and certain regions of their bodies. Furthermore, their 'ideal' body shape was significantly slimmer than their perceived current body shape, and slimmer even than that of the non-dieters. This pattern held for both the nine- and 14-year-olds, of whom half of each age group were of average or below average weight index for their age. The appearance of these dispositions and behaviours by the age of nine, or possibly earlier, may result in a marked increase in future clinical eating problems and disorders.

Adolescent↗
PubMed1991

Interpersonal communication between nurses and elderly patients: refinement of an observation schedule.

The aim of the study was to refine and improve the inter-observer reliability of an observation schedule, developed by Le May & Redfern, designed to record the amount and type of nurse-patient interpersonal communication. The new technique involved observation of non-verbal interactions using a portable computer programmed as an event recorder and a tape recorder to record conversation. The observation schedule was employed in an acute/rehabilitation care of the elderly ward and inter-observer reliability was tested on two occasions. The second observer used a handwritten version of the schedule. Reliability coefficients were acceptable (greater than or equal to 0.60 or greater than or equal to 70% agreement) for all the schedule components although the recording of non-verbal response was inadequate. Use of the portable computer produced no additional benefits over the handwritten schedule. The observation confirmed previous research which found that relatively little expressive touch takes place between nurses and elderly patients. A simplified version of the handwritten schedule together with tape-recording of verbal communication is likely to increase reliability.

Aged↗
PubMed1991

Detection of micro-organisms using a two bottle blood culture system: a twelve month study.

Over a twelve month period the isolation rate of pathogens, frequency of isolation of non-significant organisms, and time taken to detect positive cultures from a two-bottle blood culture system were analysed. Of 6916 blood cultures collected, 978 organisms were isolated from 863 cultures, 540 organisms being considered clinically significant and the majority (81%) being isolated within 48 h. Our results showed that use of more than one bottle increased the general isolation rate, with both bottles facilitating growth independently. This situation was particularly apparent in the cases of Haemophilus influenzae and Neisseria meningitidis, which showed that using the system alone only 76% and 33% (respectively) of the total number of strains would have been isolated. The results of this study reinforce the need for a second bottle containing a suitable culture medium.

Adolescent↗
PubMed1991

A successful decade of regionalized perinatal care in Tennessee: the neonatal experience.

We hypothesized that successful implementation of regionalized perinatal care would result in early identification and antenatal referral of high-risk neonates, and also improved stabilization before and during transport of those transferred postnatally. We conducted a retrospective study of demographic characteristics and transport outcome in two defined groups of neonates transported to regional perinatal centers in Tennessee, one group (n = 218) from the first year of regionalization (1975), and a second group (n = 261) from the 12th year (1986). The percentage of outborn infants decreased, from 50% of all admissions in 1975 to 22% in 1986 (P = .005). Likewise, the percentage of low-birthweight neonates transported after birth decreased, from 59% of all transports to 32% (P = .002). The frequency of stabilization measures performed before and during transport increased between study years (intravenous line placement: 12% to 58%, P = .0001; assisted ventilation: 10% to 33%, P = .001). The incidence of complications during transport decreased between study years (cyanosis: 25% to 8%, P = .0001; hypothermia: 30% to 3%, P = .0001; acidemia: 33% to 13%, P = .011). Both transport-related mortality and neonatal mortality decreased between study years (2.8% to 0.8%, P = .043; 17% to 7%, P = .0001, respectively). We conclude that regionalization during its first decade has been successful in improving perinatal care in Tennessee as indicated by favorable changes in referral patterns and improved outcome of transported neonates.

Humans↗
PubMed1990

Pseudomonas septicaemia after endoscopic retrograde cholangiopancreatography--an unresolved problem.

Over a 6-month period 5 patients with obstructive jaundice developed Gram-negative septicaemia, all within 48 hours of undergoing endoscopic retrograde cholangiopancreatography. The sepsis proved fatal in 3 patients, despite prompt decompression of the obstructed biliary system. In all cases the organism responsible was Pseudomonas aeruginosa and the source of infection appeared to be a contaminated water-bottle attached to the endoscopic apparatus. This report highlights the importance of disinfection techniques and reviews the present situation in respect of antibiotic prophylaxis.

Aged↗