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At least 685 records · Page 38Linked to original sources
PubMed1998

Effects of tacrolimus on hyperlipidemia after successful renal transplantation: a Southeastern Organ Procurement Foundation multicenter clinical study.

BACKGROUND: Tacrolimus has been shown to have a less adverse effect on the lipid profiles of transplant patients when the drug is started as induction therapy. In order to determine the effect tacrolimus has on lipid profiles in stable cyclosporine-treated renal transplant patients with established hyperlipidemia, a randomized prospective study was undertaken by the Southeastern Organ Procurement Foundation. METHODS: Patients of the 13 transplant centers, with cholesterol of 240 mg/dl or greater, who were at least 1 year posttransplant with stable renal function, were randomly assigned to remain on cyclosporine (control) or converted to tacrolimus. Patients converted to tacrolimus were maintained at a level of 5-15 ng/ml, and control patients remained at their previous levels of cyclosporine. Concurrent immunosuppressants were not changed. Levels of total cholesterol, triglycerides, total high-density lipoprotein, low-density lipoprotein (LDL), very-low-density lipoprotein, and apoproteins A and B were monitored before conversion and at months 1, 3, and 6. Renal function and glucose control were evaluated at the beginning and end of the study (month 6). RESULTS: A total of 65 patients were enrolled; 12 patients failed to complete the study. None were removed as a result of acute rejection or graft failure. Fifty-three patients were available for analysis (27 in the tacrolimus group and 26 controls). Demographics were not different between groups. In patients converted to tacrolimus treatment, there was a -55 mg/dl (-16%) (P=0.0031) change in cholesterol, a -48 mg/dl (-25%) (P=0.0014) change in LDL cholesterol, and a -36 mg/dl (-23%) (P=0.034) change in apolipoprotein B. There was no change in renal function, glycemic control, or incidence of new onset diabetes mellitus in the tacrolimus group. CONCLUSION: Conversion from cyclosporine to tacrolimus can be safely done after successful transplantation. Introduction of tacrolimus to a stable renal patient does not effect renal function or glycemic control. Tacrolimus can lower cholesterol, LDL, and apolipoprotein B. Conversion to tacrolimus from cyclosporine should be considered in the treatment of posttransplant hyperlipidemia.

Adult↗
PubMedDate not supplied

Fundamental or foundational obligation? Problematizing the ethical call to spiritual care in nursing.

Spiritual nursing care is increasingly being cited in the nursing literature as a fundamental ethical obligation. This obligation is based upon the argument that nurses provide holistic care, spirituality is a universal dimension of the person, and so nurses should care for the spiritual dimension. However, the literature on the spiritual dimension in nursing illustrates widely differing foundational assumptions about this important aspect of care. The philosophic categories of humanism, theism, and monism can be used to illustrate the different understandings of the spiritual dimension, and the implications of these understandings for the competence of the nurse and the nature of the nurse-patient interaction in the context of spiritual care.

Clinical Competence↗
PubMedDate not supplied

The recovery process in major depression: an analysis employing Meleis' transition framework for deeper understanding as a foundation for nursing interventions.

The number of persons with mental illness is increasing globally; despite this fact, nursing research on research-based interventions to prevent or minimize illness and increase quality of life is sparse. The purpose of this secondary analysis of men and women recovering from major depression (N = 25) was to gain a deeper understanding of the concept of transition in the recovery process associated with major depression as well as to develop and suggest nursing interventions that support the recovery process. The transition framework was useful, as it was describing the transition process as fluid, going back and forth, which was confirmed by the respondents' statements. Transition planning is a feasible way of supporting both the recovery process and health promotion, thus laying the foundations for a good quality of life.

Activities of Daily Living↗
PubMed1997

The National Kidney Foundation Dialysis Outcomes Quality Initiative.

Rigorously developed clinical practice guidelines have the potential to change practice patterns to obtain improved patient outcomes. Toward that end, in March 1995 the National Kidney Foundation initiated the Dialysis Outcomes Quality Initiative, a comprehensive effort to create literature-based clinical practice guidelines in nephrology. Independent interdisciplinary work groups reviewed the available body of scientific literature on the following topics: hemodialysis adequacy, peritoneal dialysis adequacy, vascular access, and anemia. More than 11,000 papers were identified; of these approximately 1500 were found to be relevant, requiring formal structured review. Work groups formulated draft guidelines with supporting rationales that included the evidentiary basis for the recommendations. The draft guidelines were subjected to an unprecedented three-stage review process that involved more than 50 organizations from the renal community, including end-stage renal disease networks, patients dialysis providers, managed care organizations, and government. The finalized guidelines were issued in September 1997. Planned guideline implementation activities will focus on achieving the following: cooperation from the renal community; education of patients, clinicians, policy makers, and dialysis providers; information system tools to facilitate adoption of the guidelines; and evaluation strategies to determine whether practice patterns and outcome goals are achieved.

Humans↗
PubMed1986

Ecogenetics: historical foundation and current status.

This paper will provide an introduction to the concept of ecogenetics, including its historical foundations. Specific genetic conditions (more than 30), including those involving RBCs and liver conditions, serum proteins, skin disorders, DNA repair diseases, and others that either theoretically or experimentally have been shown to enhance susceptibility to toxic substances, will be identified and evaluated with respect to their capacity to enhance risk, their frequency in the population, and their ability to be identified in screening tests.

Disease Susceptibility↗
PubMed1998

Foundations of genetics: genetic structure, function, and therapeutics.

Molecular genetics provides the basis for understanding patterns of health and disease in people and is part of the scientific foundation on which acute and critical care nurses should build their practice. The human genome, defined as all the genetic information in the cells of humans, provides the blueprint for protein production and cellular function in the body. Alterations in protein production may result in illness or organ malfunction that has a genetic derivation. One therapeutic strategy that holds promise to manage genetic diseases is gene therapy. Gene therapy, or human gene transfer, occurs when scientists or physicians modify the genetic material in cells for therapeutic purposes. Genetic structure, function, and therapeutic reflect the science of the present and future and have profound practice implications for acute and critical care nurses.

Genetic Diseases, Inborn↗
PubMed2005

Health-related quality of life improves in children and adolescents with inflammatory bowel disease after attending a camp sponsored by the Crohn's and Colitis Foundation of America.

PURPOSE: To describe the reported health-related quality of life (HRQOL) in children and adolescents with inflammatory bowel disease (IBD) after attending an IBD summer camp. METHODS: A prospective analysis of quality of life was completed at an overnight camp that was exclusively for patients with IBD, which was sponsored by the Crohn's and Colitis Foundation of America. The IMPACT-II questionnaire (Canada and United States) and the State-Trait Anxiety Inventory for Children were administered to the campers at the beginning and at the end of a 1-week camp to assess HRQOL and anxiety. The IMPACT-II questionnaire consists of 35 questions measuring 6 quality-of-life domains (i.e., bowel domain, systemic symptoms, emotional functioning, social functioning, body image, and treatment/interventions). The State-Trait Anxiety Inventory for Children consists of 2 different 20-item sets of questions. One set assesses state anxiety, and the other, trait anxiety. A repeated-measures multivariate analysis of variance was performed to determine the differences between scores attained before and after camp on the IMPACT-II questionnaire and in each of its domains. Paired sample t tests were performed on state and trait anxiety before and after camp. RESULTS: A total of 125 individuals consented to participate, but 61 patients (50 girls and 11 boys; age range, 9 to 16 y) completed the IMPACT-II questionnaire in full. Of those 61 patients, 47 had Crohn's disease and 14 had ulcerative colitis. There was statistically significant improvement between the mean (+/-SD) precamp total score (172.95 +/- 36.61) and the mean postcamp total score (178.71 +/- 40.97; P = 0.035), bowel symptoms scores (P = 0.036), social functioning scores (P = 0.022), and treatment interventions scores (P = 0.012). No difference was found between anxiety scores before and after camp on either the state or trait anxiety inventories (n = 55; P > 0.05). CONCLUSIONS: Overall, HRQOL improved in children after attending IBD summer camp. This exploratory study suggests that contributing factors for these improvements may be an increase in social functioning, a better acceptance of IBD symptoms, and less distress regarding treatment interventions, suggesting that a camp that is specifically designed for children with IBD may normalize the chronic illness experience. However, future research using a multimodal measurement approach is warranted to support these conclusions.

Adolescent↗
PubMed2001

The role of myocilin/TIGR in glaucoma: results of the Glaucoma Research Foundation catalyst meeting in Berkeley, California, March 2000.

Approximately 3 years ago, the first major (biochemical, molecular biologic, and biologic) insight into primary open-angle glaucoma was the finding that mutations in the myocilin (MYOC/TIGR) gene were related to certain forms of juvenile onset of this disease. Since then, a great deal of work has been done to determine the possible mechanisms by which MYOC/TIGR might cause not only juvenile but also adult-onset primary open-angle glaucoma. To assess the current knowledge and those areas in which more research is necessary, a meeting of scientists was held by the Glaucoma Research Foundation of San Francisco, California in the spring of 2000. This meeting attempted to concentrate on the MYOC/TIGR protein rather than the genetics of this gene. Possible functions and roles of this protein intracellularly and extracellularly were critically examined and discussed. Normal transcriptional and translational events and the effect of mutations on these events were explored. The discussions yielded insight not only in those areas in which important information is known but also in vital areas in which little is currently understood. This review attempts to summarize the current knowledge regarding MYOC/TIGR and to elucidate the points that the people attending the meeting thought needed further study.

Cytoskeletal Proteins↗
PubMedDate not supplied

Pyramids to success: laying the foundation for professional practice.

Communication plays a vital role in an increasingly complex healthcare environment. Quality patient outcomes and successful collaboration depend upon the healthcare provider's ability to communicate needs. A self-directed work team at a large southeastern hospital used a quality improvement process to design a new series of workshops to enhance staff communication skills. The redesigned programming reduced duplication of education content and built upon a conceptual foundation that cultivates professional development. The workshops feature content such as self-awareness, personal effectiveness, and leadership of others.

Academic Medical Centers↗
PubMed2004

Dead regions in the cochlea: conceptual foundations, diagnosis, and clinical applications.

Regions in the cochlea with no (or very few) functioning inner hair cells and/or neurons are called "dead regions". This paper reviews the anatomical, physiological, and psychophysical foundations for the concept of dead regions. It then considers methods that have been used to diagnose dead regions, focusing particularly on psychophysical tuning curves and the test using threshold-equalizing noise. Problems and limitations of each approach are discussed. Applications of tests for diagnosing dead regions are described. These include: giving the client realistic expectation about the likely benefit of a hearing aid; guidance in the fitting of hearing aids; assessment of candidacy for cochlear implants; assessment of hearing loss for medico-legal applications. Finally, guidelines for implementation of the threshold-equalizing noise test in clinical practice are given.

Audiometry↗
PubMed2006

Proposed quality measures for palliative care in the critically ill: a consensus from the Robert Wood Johnson Foundation Critical Care Workgroup.

For critically ill patients and their loved ones, high-quality health care includes the provision of excellent palliative care. To achieve this goal, the healthcare system needs to identify, measure, and report specific targets for quality palliative care for critically ill or injured patients. Our objective was to use a consensus process to develop a preliminary set of quality measures to assess palliative care in the critically ill. We built on earlier and ongoing efforts of the Robert Wood Johnson Foundation Critical Care End-of-Life Peer Workgroup to propose specific measures of the structure and process of palliative care. We used an informal iterative consensus process to identify and refine a set of candidate quality measures. These candidate measures were developed by reviewing previous literature reviews, supplementing the evidence base with recently published systematic reviews and consensus statements, identifying existing indicators and measures, and adapting indicators from related fields for our objective. Among our primary sources, we identified existing measures from the Voluntary Hospital Association's Transformation of the ICU program and a government-sponsored systematic review performed by RAND Health to identify palliative care quality measures for cancer care. Our consensus group proposes 18 quality measures to assess the quality of palliative care for the critically ill and injured. A total of 14 of the proposed measures assess processes of care at the patient level, and four measures explore structural aspects of critical care delivery. Future research is needed to assess the relationship of these measures to desired health outcomes. Subsequent measure sets should also attempt to include outcome measures, such as patient or surrogate satisfaction, as the field develops the means to rigorously measure such outcomes. The proposed measures are intended to stimulate further discussion, testing, and refinement for quality of care measurement and enhancement.

Continuity of Patient Care↗
PubMed2002

Technical foundations for noninvasive assessment of changes in the width of the subarachnoid space with near-infrared transillumination-backscattering sounding (NIR-TBSS).

This paper presents technical foundations for a new technique of near-infrared transillumination-backscattering sounding, which is designed to enable noninvasive detection and monitoring of changes in the width of the subarachnoid space (SAS) and magnitude of cerebrovascular pulsation in humans. The key novelty of the technique is elimination of influence of blood flow in the scalp on the signals received from two infrared sensors-proximal and distal. A dedicated digital algorithm is used to estimate on line the ratio of the powers of received signals, referred to as two-sensor distal-to-proximal received power quotient, TQ (t). The propagation duct for NIR radiation reaching the distal sensor is the SAS filled with translucent cerebrospinal fluid. Information on slow fluctuations of the average width of the SAS is contained in the slow-variable part of the TQ (t), called the subcardiac component, and in TQ itself. Variations in frequency and magnitude of faster oscillations of the width of that space around the baseline value, dependent on cerebrovascular pulsation, are reflected in instantaneous frequency and envelope of the fast-variable component. Frequency and magnitude of the cerebrovascular pulsation depend on the action of the heart, so this fast-variable component is referred to as the cardiac component.

Algorithms↗
PubMed1999

Foundations, frameworks, lenses: the role of theories in bioethics.

I explore the implications of the foundation metaphor for understanding the role of moral theories in ethics and bioethics and argue that its disadvantages outweigh its advantages. I then consider two other metaphors that might be used instead, those of frameworks and lenses. I propose that the metaphor of lenses is most promising in providing methodological guidance for drawing on moral theories when deliberating about bioethical problems.

Bioethics↗
PubMed2004

Motivational enhancement and other brief interventions for adolescent substance abuse: foundations, applications and evaluations.

AIMS: To present a comprehensive review of the use of motivational enhancement and other brief interventions for substance use in adolescents. METHODS: In this paper, we review the major theoretical foundations and influences of brief interventions (including motivational interviewing), consider developmental issues in its application for adolescents, discuss methodological issues in the design and implementation of brief interventions, including the assessment of treatment fidelity, evaluate and interpret the latest findings on brief interventions for adolescents and young people and discuss the issue of translating and exporting effective research into practice. FINDINGS: Results from recent clinical trials using motivational interventions indicate that these approaches result in decreases in substance-related negative consequences and problems, decrements in substance use and increased treatment engagement, with results particularly strong for those with heavier substance use patterns and/or less motivation to change. CONCLUSION: While results are promising, more research is needed to examine the essential elements of motivational interventions, for whom they work best, and their impact on developmental transitions during adolescence.

Adolescent↗
PubMed1991

An evaluation of the Ulster Cancer Foundation's Nurses and Smoking Package and its impact on student nurses.

The Ulster Cancer Foundation's teaching package Nurses and Smoking was evaluated by testing nurses' knowledge and skills in the area of smoking-related health education. As smoking is still a major cause of mortality and morbidity, does the nurses' training equip them with an adequate knowledge of its consequences? Questionnaire data, together with material from in-depth interviews, were analysed and pre- and post-package results produced significant differences (P less than 0.001) between the experimental and control groups, suggesting that a teaching package significantly improves a nurse's knowledge and expertise with regard to smoking and its effect on both patients and their environment.

Attitude↗
PubMed2005

Developing an education and assessment framework for the Foundation Programme.

AIM: To develop an education and assessment framework for the second year of the Foundation Programme (F2). METHODS: A total of 23 PRHOs were recruited to the F2 pilot in August 2003. The training posts included a variety of specialties at 2 hospital trusts plus primary care. Trainee expectations and satisfaction were evaluated using questionnaires administered before and at the end of the pilot. At the end of the pilot, 10 trainees participated in a focus group and 19 trainers participated in a semistructured telephone interview. RESULTS: The majority of trainees (78%) felt that their expectations of the F2 pilot were met and all felt that they had improved their generic skills. Attendance at the generic education programme was 95%. The majority of trainees found the assessment framework useful. The percentage of undecided trainees in terms of career aspirations dropped from 48% to 13%. Trainees valued the breadth of experience provide by the year and the support provided by the programme directors and each other. A need for better communication, administrative support and time for assessment was highlighted by the trainers. CONCLUSIONS: Early, focused education on generic skills will benefit both doctors and their patients. More varied career experience will help to ensure that doctors make appropriate and timely career decisions. Pilots are identifying good practice and areas that need improvement.

Attitude↗
PubMed2006

Class half-empty? Pre-registration house officer attendance at weekly teaching sessions: implications for delivering the new Foundation Programme curriculum.

This study aimed to explore patterns of attendance at classroom-based, taught education programmes for pre-registration house officers (PRHOs) and to identify reasons for non-attendance, and to consider implications for Foundation Programme curriculum delivery and suggest strategies for improving delivery. We analysed registers of attendance for education sessions for 3 local teaching hospitals in the Leicestershire, Northamptonshire and Rutland (LNR) Healthcare Workforce Deanery, along with PRHO exit questionnaire returns (from 2001 to 2005). Despite a trend for attendance to fall slightly over the course of a rotation, attendance rates have, in general, remained relatively stable at around two-thirds. However, during most 4-month posts, a fifth or more of PRHOs missed half or more of all sessions. Two types of barrier to attendance were identified: 'routine barriers', which relate to hospital working patterns, and 'contextual barriers', which refer to the particularities of each hospital post. There was no evidence that doctors' motivation and commitment towards the education programme is a main determinant of attendance. Contextual barriers to attendance, such as pressure being placed on PRHOs to remain on the ward, can be addressed. However, routine barriers to attendance, including on-call working patterns and annual leave, render it impossible to avoid significant numbers of education sessions being missed by PRHOs in each post during a rotation. En bloc teaching of basic generic skills prior to the start of the rotation plus greater use of online learning resources are examples of ways in which reliance on in-post, classroom-based programmes can be reduced.

Attitude of Health Personnel↗
PubMed2005

A case study of a preceptorship programme in an acute NHS Trust--using the European Foundation for Quality Management tool to support clinical practice development.

AIMS: To discuss the results of the evaluation, assessment and effectiveness of the trust-wide clinical practice development of a preceptorship programme for newly qualified nurses at Salford Royal Hospitals NHS Trust. To apply the European Foundation for Quality Management (EFQM) model as a tool for monitoring and assessing the performance of the programme. BACKGROUND: Newly qualified nurses need support and preparation for their working role in their first recruitment. A preceptorship programme, developed around a quality-monitoring framework, was introduced to address this need at Salford Royal, an acute NHS Trust. METHOD: The generic EFQM model was adapted to the specific case of the preceptorship programme. A questionnaire survey was undertaken to obtain evidence to assess how the EFQM tool was applied in the context of the preceptorship programme. Pre- and post-programme questionnaires were sent to preceptees and post-programme questionnaires to respective ward managers. FINDINGS: Following introduction of the preceptorship programme, recruitment and retention of newly qualified nurses have increased, with preceptees self-reporting increased levels of confidence. Use of the EFQM tool has provided the information that managers and departments require. Anecdotal evidence to date suggests that barriers are being broken down. Utilization of the framework has also identified areas of practice that need to change. CONCLUSIONS: This paper demonstrates how use of a generic tool such as EFQM can provide systematic and evaluative information for nursing.

Clinical Competence↗