Biomedical subjects
A Humphreys
Publications and source records attributed to A Humphreys.
Nurse management of patients with minor illnesses in general practice: multicentre, randomised controlled trial.
OBJECTIVE: To assess the acceptability and safety of a minor illness service led by practice nurses in general practice. DESIGN: Multicentre, randomised controlled trial. SETTING: 5 general practices in south east London and Kent representing semi-rural, suburban, and urban settings. PARTICIPANTS: 1815 patients requesting and offered same day appointments by receptionists. INTERVENTION: Patients were assigned to treatment by either a specially trained nurse or a general practitioner. Patients seen by a nurse were referred to a general practitioner when appropriate. MAIN OUTCOME MEASURES: The general satisfaction of the patients as measured by the consultation satisfaction questionnaire. Other outcome measures included the length of the consultation, number of prescriptions written, rates of referral to general practitioners, patient's reported health status, patient's anticipated behaviour in seeking health care in future, and number of patients who returned to the surgery, visits to accident and emergency, and out of hours calls to doctors. RESULTS: Patients were very satisfied with both nurses and doctors, but they were significantly more satisfied with their consultations with nurses (mean (SD) score of satisfaction 78.6 (16. 0) of 100 points for nurses v 76.4 (17.8) for doctors; 95% confidence interval for difference between means -4.07 to -0.38). Consultations with nurses took about 10 minutes compared with about 8 minutes for consultations with doctors. Nurses and doctors wrote prescriptions for a similar proportion of patients (nurses 481/736 (65.4%) v doctors 518/816 (63.5%)). 577/790 (73%) patients seen by nurses were managed without any input from doctors. CONCLUSION: Practice nurses seem to offer an effective service for patients with minor illnesses who request same day appointments.
Prognostic value of negative transesophageal dobutamine stress echocardiography in men at high risk for coronary artery disease.
Recently published reviews have called into question the sensitvity of transthoracic stress echocardiography to predict cardiac events, especially when the test is negative, compared with myocardial perfusion imaging studies. To our knowledge there are a lack of data assessing the prognostic value of transesophageal echocardiography-dobutamine stress echocardiography (TEE-DSE) in predicting cardiac events. Because TEE-DSE has been reported to be highly accurate for detecting ischemia in patients with suspected coronary artery disease, we tested the hypothesis that a negative TEE-DSE can identify a low-risk group in a population with a high likelihood of coronary artery disease. Between October 1996 and December 1997, 46 high-risk patients with negative TEE-DSE were identified. Annualized pretest risk for all cardiac events using the Framingham model was 4% based on risk factors. Mean age was 64 years. Mean follow-up time was 16.2 months. There were no cardiac deaths. There were 6 soft and 1 hard cardiac event. The annualized combined ischemic cardiac event rate was 3.8%, and for hard cardiac events it was 1.1%. By Kaplan-Meier analysis, 97% of the population remained free of any ischemic event at the end of 1 year and 93% were free at 22 months. We conclude that optimal image quality and enhanced endocardial definition for assessing wall motion changes with TEE translates into better prognostication and approaches that of myocardial perfusion imaging for negative studies. Advances in ultrasound medicine such as contrast enhancement of myocardial definition, which improve diagnostic accuracy of DSE, should translate into better prognostication.
The nature and purpose of the role of the nurse lecturer in practice settings.
This paper examines the role of lecturers in nursing in pre-registration education. It focuses on the nature and purpose of the nurse lecturer's contribution in the practice setting, with particular emphasis on the issues surrounding clinical credibility. This is particularly pertinent in the light of current recommendations, which emphasise the importance of clinical learning in pre-registration education programmes. The purpose of the lecturer's role in clinical practice settings is ill defined. This lack of clear consensus regarding the expected outcomes for lecturers (in practice), leads to difficulty outlining what they should do in practice settings. Although lecturers accept that they have an important part to play in maximizing the learning opportunities for students in both university and practice settings, they are less clear about how this should be achieved in the latter. This paper argues that: It is opportune to examine and realign the lecturers contribution in practice settings given that there has been a shift in the responsibility for clinical learning; nurse education is now embedded in the higher education sector and there is a need for a greater emphasis on practice development. Clinical credibility for lecturers is about the development of nursing practice through education which is not always achieved by 'hands on' care. For example, assisting nurses in a ward area to develop expertise in evidence based practice may not involve 'hands on' care giving but does involve being conversant with current research and practice issues. The lecturer's expertise in practice settings is in teaching and facilitating learning, rather than direct care giving. No one common model for practice may be either feasible or desirable. However, it is important that nurse lecturers do not follow a particular approach because the debate about the nurse lecturer's role in practice settings fails to acknowledge the strengths and weaknesses of each model. It is important that the approach is based on sound rationale.
The role of the personal tutor in the academic context.
This paper is the second of a series on the role of the nurse teacher and is based on a review of the literature and the personal experience of the authors. Identifying the most appropriate way to support students in both the academic and clinical setting has been a major concern for nurse teachers. The move of nurse education into the higher education arena has increased the diverse nature of the nurse teachers role and raised questions about the nature and function of the personal tutor in relation to students undertaking nursing courses. This paper discusses the concept of the personal tutor, with particular focus on the academic aspects of the role. The time implication of adopting an all encompassing personal tutor role, within the current climate of higher education, is considered. The paper also highlights that the roles tutors adopt in practice are diverse and usually as a result of convenience rather than identified outcomes.
Home care for stem cell transplantation patients.
Following high-dose chemotherapy patients need to undergo bone marrow rescue through stem cell transplantation. Patients who received stem cell transplantation at home expressed satisfaction with this form of therapy. Performing stem cell transplantation in the home can reduce both costs and the risk of infection.
A phase I clinical study of the antipurine antifolate lometrexol (DDATHF) given with oral folic acid.
Lometrexol is an antifolate which inhibits glycinamide ribonucleotide formyltransferase (GARFT), an enzyme essential for de novo purine synthesis. Extensive experimental and limited clinical data have shown that lometrexol has activity against tumours which are refractory to other drugs, notably methotrexate. However, the initial clinical development of lometrexol was curtailed because of severe and cumulative antiproliferative toxicities. Preclinical murine studies demonstrated that the toxicity of lometrexol can be prevented by low dose folic acid administration, i.e. for 7 days prior to and 7 days following a single bolus dose. This observation prompted a Phase I clinical study of lometrexol given with folic acid supplementation which has confirmed that the toxicity of lometrexol can be markedly reduced by folic acid supplementation. Thrombocytopenia and mucositis were the major toxicities. There was no clear relationship between clinical toxicity and the extent of plasma folate elevation. Associated studies demonstrated that lometrexol plasma pharmacokinetics were not altered by folic acid administration indicating that supplementation is unlikely to reduce toxicity by enhancing lometrexol plasma clearance. The work described in this report has identified for the first time a clinically acceptable schedule for the administration of a GARFT inhibitor. This information will facilitate the future evaluation of this class of compounds in cancer therapy.
Carboplatin in combination with paclitaxel in advanced ovarian cancer: dose determination and pharmacokinetic and pharmacodynamic interactions.
Data from various phase I/II studies of carboplatin in combination with paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) have suggested that the degree of thrombocytopenia seen is less than that expected when carboplatin is given alone. However, some studies also have suggested that the area under the plasma concentration-time curve (AUC) of carboplatin is lower than that expected, raising the possibility of a pharmacokinetic interaction. Patients with advanced epithelial ovarian cancer were treated with first-line carboplatin (AUC = 7, using the 51Cr EDTA [edetic acid] clearance method) and escalating doses of paclitaxel. Thrombocytopenia was mild and was significantly less when the paclitaxel dose was 175 mg/m2 versus 150 mg/m2. Paclitaxel kinetics were nonlinear, as previously reported. The achieved carboplatin AUC was 7 +/- 1 mg/mL.min, indicating that the pharmacokinetics of carboplatin are not affected by paclitaxel. Glomerular filtration rates measured in 184 patients using the 51Cr EDTA clearance method were compared with rates estimated from the plasma creatinine level using the Cockcroft-Gault or Jeliffe formulas and showed a significant bias of these two formulas. Clearances above 50 mL/min were underestimated by an amount that became greater as the clearance increased and was approximately 25% to 35% for patients with clearances in the normal range. Since creatinine-based methods have been used in many previous studies, care is needed in interpreting the predicted AUC values from these studies. Carboplatin and paclitaxel may be given safely in combination at full doses, and the thrombocytopenia seen is significantly less than that observed with single-agent carboplatin. No evidence exists of a pharmacokinetic interaction, and the observation in some studies that the carboplatin AUC was lower than expected was probably due to the methodology used to estimate the glomerular filtration rate.
Acute dystonic drug reaction or tetanus? An unusual consequence of a 'Whizz' overdose.
The case history presented illustrates that, following an overdose of 'Whizz' and alcohol, a protracted dystonic syndrome can develop, clinically indistinguishable from tetanus. A prolonged period of ventilation may be necessary, but, in this case, complete recovery eventually occurred.
Hepatolenticular degeneration--Wilson's disease.
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Reflection: does it enhance professional nursing practice?
It is generally accepted that nurses who engage in reflective activity do so to develop their practice. However, there is little empirical evidence to suggest that practice development or improved patient care occurs as a direct result of reflection. The UKCC, as part of its framework for postregistration education, expects all nurses to engage in some form of reflective activity and to provide written accounts within a personal professional profile. This article examines some of the assumptions surrounding the practice of reflection and asserts that, in the main, nurses do not readily engage in reflection in a purposeful way.
Are black nurses an endangered species?
In the late 1980s it was feared that black nurses in Britain were a dying species. There was a belief that young people of minority ethnic descent were being deterred from choosing nursing as a career owing to the discrimination, disadvantage and harassment experienced by their parents as health service workers. Anecdotal evidence and limited statistical evidence suggested that the number of black applicants to preregistration training in nursing and midwifery was lower than would be expected when compared with the representation of the minority ethnic groups in the population as a whole. Nevertheless, the evidential base has, to date, been limited. Using the most comprehensive data set available, this paper presents an analysis of the national pattern of applications from members of minority ethnic groups to preregistration nursing and midwifery training. The evidence indicates complex patterns of under- and, in some cases, over-representation of black and Asian minority ethnic groups.