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Biomedical subjects

A Irwin

Publications and source records attributed to A Irwin.

16 recordsLinked to original sources
PubMed2006

The nurse's role in the management of aggression.

Although research into the phenomenon of aggression within psychiatric inpatient settings has established a strong casual link with mental illness, there is widespread agreement that diagnostic or demographic characteristics cannot accurately predict such behaviours. In addition, studies have consistently failed to establish how nursing management responses influence the course of aggression within these environments. Therefore, an assumption can be made that specific contextual factors are significant, and that management responses have an effect on outcomes. This review examines the nurses' impact on inpatient aggression and how management strategies affect the therapeutic value of intervention.

Aggression↗
PubMed2001

Predicting a patient's choice of dialysis modality: experience in a United Kingdom renal department.

Education and counseling are important aspects of the management of patients starting dialysis. Free choice of modality may enhance patient well-being and, in the absence of clear survival benefits for either hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD), should have the major role in modality selection. This prospective study examines factors influencing this choice. Three hundred thirty-three new patients started renal replacement therapy at Birmingham Heartlands Hospital (Birmingham, UK) between August 1, 1992, and July 31, 1998. Data were incomplete for 14 patients, 11 patients were not counseled, and 54 patients had contraindications to a particular modality. The remaining 254 patients were offered a free choice. One hundred thirty-nine patients (55%) chose HD and 115 patients (45%) chose CAPD. Independent predictors for choosing CAPD rather than HD were being married (P = 0.004), being counseled before the start of dialysis (P = 0.019), and increased distance from the base unit (P < 0.001). Independent predictors for choosing HD were increasing age (P = 0.030) and male sex (P = 0.041). Use of these data should enhance planning of dialysis services and bring nearer the goal that all new patients with ESRD are able to have the dialysis modality of their choice.

Adolescent↗
PubMed2001

Hospital at home services for acute exacerbation of chronic obstructive pulmonary disease: a survey of British practice.

OBJECTIVES: To identify the prevalence of and attitudes towards hospital at home services for acute exacerbation of chronic obstructive pulmonary disease (COPD) in Great Britain. To identify the models of service in existence, in particular staff numbers and the workload experienced. DESIGN: A postal survey was used to locate existing schemes. Telephone interviews were conducted with each of the hospital at home services identified. SUBJECTS & SETTING: A questionnaire was sent to one consultant in each of 223 respiratory departments in Great Britain. Thirty six departments were subsequently contacted by telephone. OUTCOME MEASURES: Awareness and prevalence of hospital at home services. Perceived problems with starting a service. Details of organisation of existing services. RESULTS: We received 186 replies to the postal questionnaire. Of these respiratory departments, 179 (96%) were aware of hospital at home services for acute exacerbation of COPD and, in November 1999, 30 (16%) were running such a service. Difficulty in obtaining funding was the main reason for not setting up a service rather than lack of evidence of benefit or unsuitability of local circumstances. Median staffing level was two nurses (range one to six) looking after a median number of new patients of five per week (range 0.5 to 12). There was wide variation in the organisation of services. CONCLUSIONS: Despite lack of objective evidence of effectiveness, there was a high level of awareness of and interest in starting hospital at home services for acute exacerbation of COPD in British respiratory departments when assessed in November 1999.

Acute Disease↗
PubMed1999

An acute respiratory assessment service.

Physicians are often unclear about which patients with exacerbation of COPD require hospital admission. Hospital assessment with nurse-led domiciliary follow-up can be appropriate for some patients. Such a service is highly acceptable to both patients and GPs.

Acute Disease↗
PubMed1998

Home treatment of exacerbations of chronic obstructive pulmonary disease by an acute respiratory assessment service.

BACKGROUND: Exacerbations of chronic obstructive pulmonary disease are a major cause of hospital admissions, but do not require intensive investigation or complex therapy. We investigated the suitability of home care for severe uncomplicated exacerbations. METHODS: Over 3.5 years we assessed 962 patients with exacerbations of chronic obstructive pulmonary disease after referral to a hospital respiratory department by their family physicians. All patients had chest radiographs, oxygen-saturation or arterial-gas analysis, spirometry, and physical assessment. Unless admission was thought to be essential, patients were allowed home with a customised treatment package. Each patient was visited daily by a respiratory nurse who monitored progress and treatment compliance and provided education and reassurance. FINDINGS: 145 (15%) of 962 required admission at initial referral and 115 (12%) were admitted later. 653 (68%) patients were managed entirely at home and 49 (5%) were referred inappropriately. One patient died at home. All patients had severe disease with a mean forced expiratory volume in 1 s of 1.02 L and 395 (41%) had required hospital admission in the previous year. INTERPRETATION: After formal assessment in a hospital respiratory unit, many patients with exacerbations of chronic obstructive pulmonary disease can be treated at home by respiratory nurses.

Acute Disease↗
PubMed1997

Modified Burton and Pellegrini procedure for trapezium excision, ligament reconstruction and interposition arthroplasty of the tendon of flexor Carpi radialis.

GOAL OF SURGERY: Relieve of pain and increased stability at the base of 1st metacarpal. INDICATIONS: Painful degenerative and inflammatory arthritis in trapeziometacarpal joint (TMCJ). CONTRAINDICATIONS: Patients not willing to undergo lengthy intensive postoperative rehabilitation. Rheumatoid arthritis (relative). POSITIONING AND ANAESTHESIA: Supine. Hand table. General or regional anaesthesia. SURGICAL TECHNIQUE: Modification of the Burton-Pelligrini operation by using half of the flexor carpi radialis for interposition between base of 1st metacarpal and scaphoid. Stabilization with a Kirschner wire. In the presence of scaphotrapezoid arthritis an arthrodesis of this joint is performed for better pain control. POSTOPERATIVE MANAGEMENT: Immobilization in a below elbow cast for 6 weeks. Then active physiotherapy, night splint for another 6 weeks. POSSIBLE COMPLICATIONS: Fracture while drilling the base of the 1st metacarpus, migration of Kirschner wires, injury to the radial artery and cutaneous nerves. RESULTS: Out of 15 patients 12 (14 thumbs) were followed for at least 6 months. In 11 patients the shape of the hand was normal and 10 patients were satisfied with the result of the operation. Complications included: twice postoperative migration of Kirschner wires, and once intraoperative tearing of the tendon which had to be sutured.

Journal Article↗
PubMed1997

A flexible and extensible object-oriented 3D architecture: application in the development of virtual anatomy lessons.

"Anatomic VisualizeR" represents the first application to be developed using a 3D architectural framework created at the University of California, San Diego, School of Medicine. This application combines 3D anatomic models (based on the Visible Human dataset) with supporting 2D media (e.g., diagnostic imagery, surgical videos, etc.) to establish a comprehensive learning environment for anatomy. "Guided lessons" are being created to address complex curricular and learning objectives. Faculty expertise is represented in these preconfigured lessons, in part through the specification of appropriate content and the incorporation of activities to enhance visualization. These lessons are an intellectual framework which ensures that clinically-relevant issues and ancillary learning opportunities are available. The curricular exercises are non-sequential and can be interrupted at any time; users are encouraged to freely explore the environment. At the core of Anatomic VisualizeR's object-oriented architecture is the ability to identify, access, view, and manipulate heterogeneous content. The capacity to query a database gateway to retrieve specified resources has been built into the application. Encapsulation of individual elements to form 3D display objects ("blocks") enables Anatomic VisualizeR to efficiently manage 3D models, 2D images, text, sound, and video. The "block" paradigm also allows Anatomic VisualizeR to associate contextually appropriate display characteristics and behaviors with the various content elements. For example, the anatomic model block provides the capability to "link" and "unlink" the anatomic models and to alter their transparencies. The anatomic models can be displayed concurrently with other blocks to facilitate structural comparisons. Anatomic VisualizeR marks a major milestone in our developmental efforts. While lessons and database content are still not complete, we are confident that it will become the first tangible realization of our vision.

Anatomy↗
PubMed1996

Variations in morphology of the lumbosacral junction on sagittal MRI: correlation with plain radiography.

OBJECTIVE: To identify on sagittal magnetic resonance imaging (MRI) scans of the lumbar spine the features that indicate the presence of a lumbosacral transitional vertebra (LSTV). DESIGN: One hundred consecutive sagittal T1-and T2-weighted MRI scans of the lumbar spine were reviewed and separated into four types depending upon the absence or presence of disc material between what was considered to be the uppermost sacral segment and the remainder of the sacrum, as follows: type 1: no disc material present; type 2: a small residual disc, not extending for the whole anteroposterior (AP) diameter of the sacrum; type 3: a well-formed disc extending for the whole AP diameter of the sacrum; type 4: a well-formed disc extending for the whole AP diameter of the sacrum with, in addition, an abnormal upper sagittal sacral outline. The corresponding plain radiographs of each patient were than reviewed and assessed for the presence of an LSTV. These were classified according to the method of Castellvi et al. PATIENTS: All patients had been referred for MRI of the lumbar spine, usually because of back pain with or without radiculopathy. There were 51 male and 49 female patients with a mean age of 42 years and an age range of 18-85 years. RESULTS AND CONCLUSIONS: With regard to sacral morphology on MRI, 30 patients had type 1, 42 patients type 2, 16 patients type 3 and 12 patients type 4 morphology. Fifteen patients had an LSTV. There was a good correlation between the presence of a fused LSTV and a type 4 MRI appearance, indicating that this type of LSTV can be identified on sagittal MRI scans.

Adolescent↗
PubMed1995

Open fractures of the tibia in children.

The results of the treatment of open tibial fractures in 58 children aged between 3 and 15 years are reviewed. There were 25 Gustilo Type I, 22 Type II and 10 Type III fractures. At operation 37 wounds were closed primarily and 21 wounds were left open. Of these 21, 13 healed by secondary intention and eight required split skin grafting or soft tissue flap coverage. Stable fractures were immobilized in an above-knee plaster in 48 cases (83 per cent) and six fractures treated with external fixation (10 per cent). Two patients (3.5 per cent) had cast immobilization of the tibial fracture and traction for an ipsilateral femoral fracture. Two patients (3.5 per cent) with Gustilo Type IIIc injuries required an amputation, one 'de novo' as the limb was not salvageable and one 4 days after failed vascular reconstruction. All fractures healed primarily without bone grafting, although there were three cases of delayed union and seven cases of malunion. Six children had superficial wound infections but there were no cases of deep infection or osteomyelitis. There was one case of compartment syndrome.

Adolescent↗
PubMed1995

Virtual reality-multimedia synthesis: next-generation learning environments for medical education.

The Learning Resources Center of the University of California, San Diego School of Medicine has begun to investigate the potential of virtual reality (VR) as a tool for medical education. We are currently integrating VR with communications, animation, and visualization technologies to form a hybrid learning and training environment. Our program development reflects a curriculum-based strategy with emphasis on instructional objectives and educational outcomes. Demonstrated need, feasibility of a technology-based solution, and appropriateness of resource allocation are primary considerations. As the VR world is built, comparative analyses are being made of control strategies, display options, and interface design.

Computer Simulation↗
PubMed1994

Relation of boron to the composition and mechanical properties of bone.

A review of the experimental studies relating boron to biological effects on appendicular and axial bones in animal models suggests that numerous influences, known and unknown, affect the responsiveness of bone to dietary boron. Degrees of skeletal response to boron are modified by other nutritional variables that include calcium, magnesium, vitamin D, and fluoride. Evidence suggests that appendicular and axial bones may differ in their responses. Tests of the mechanical properties of bones may provide useful criteria for assessing the impacts of boron status on bone. These tests might resolve questions about optimal intakes of boron because mechanical properties sometimes respond to boron when composition of bones does not. Difficulty in interpreting some of the existing research arises because of the incipient state of knowledge regarding boron nutriture, to analytical problems associated with determining accurately the small quantities of boron in feed and tissues, and to technological difficulties in controlling extraneous exposure of experimental animals to boron. Yet there is considerable evidence that both compositional and functional properties of bone are affected by boron status.

Animals↗
PubMedDate not supplied

Through a dark glass more clearly? Health information managers and strategic planning in the 1990s.

This article considers the application of a formal strategic planning approach to the health information management profession. After a brief discussion of the two main strategic planning models, the process adopted by the Health Information Management Association of Australia at its recent strategic planning workshop is described and the planning outcomes are outlined. The merits of explicitly expressing strategic intent through the creation of a vision of the future and the establishment of strategies and an action plan to realise the vision are discussed.

Australia↗