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Biomedical subjects

A J Tierney

Publications and source records attributed to A J Tierney.

At least 19 recordsLinked to original sources
PubMed1995

Congenital diaphragmatic hernia: associated malformations--cystic adenomatoid malformation, extralobular sequestration, and laryngotracheoesophageal cleft: two case reports.

Two infants with unusual bronchopulmonary malformations associated with congenital diaphragmatic hernia (CDH) are presented. One infant had extralobular sequestration and cystic adenomatoid malformation of the lower lobe, in addition to a left-sided CDH. The second infant had a laryngotracheoesophageal cleft extending to the carina (type III) in addition to a left-sided CDH. These associated malformations can have major implications in terms of diagnosis, resuscitation, and surgical management of infants with CDH.

Abnormalities, Multiple↗
PubMed1995

Inhaled nitric oxide for premature infants after prolonged rupture of the membranes.

We evaluated the use of inhaled nitric oxide in eight premature infants (520 to 1440 gm, 24 to 31 weeks of gestation) who failed to respond to conventional management and who had prolonged rupture of the membranes and oligohydramnios. All infants had a significant improvement in oxygenation and a fall in mean airway pressure with inhaled nitric oxide. Further studies are required to determine the safety and efficacy of this form of therapy.

Administration, Inhalation↗
PubMed1995

HIV/AIDS--knowledge, attitudes and education of nurses: a review of the research.

This paper provides a review of research relating to knowledge, attitudes and education of nurses in relation to HIV/AIDS. Early studies portrayed nurses (and other health-care workers) as fearful of AIDS, ill-informed, and negative and discriminatory in their attitudes towards people with HIV/AIDS. Several major surveys in the UK in the late 1980s produced broadly similar findings and, in the absence of more recent countering evidence, it cannot be assumed that there has been significant improvement. Research surveys of HIV/AIDS education provision for nurses are also reviewed. A recent survey of UK nursing colleges revealed weaknesses in provision, and a lack of training and confidence among nurse teachers. Although evaluation research has been scarce, some studies have demonstrated the beneficial effects of various forms of education on nurses' HIV/AIDS-related knowledge and attitudes, and these are also reviewed. Although early predictions of a rapidly escalating AIDS epidemic have proved to be exaggerated, at least in developed countries, it is vital that nurses do not become complacent. This review should encourage nurses, irrespective of clinical specialty, to reconsider their own knowledge and attitudes and to press for further HIV/AIDS education if they consider that it is still lacking.

Curriculum↗
PubMed1994

Inhaled nitric oxide in infants referred for extracorporeal membrane oxygenation: dose response.

To determine the role of inhaled nitric oxide (NO) in a population of critically ill hypoxic near-term infants and to determine the dose response to inhaled NO, we examined a consecutive group of 23 infants referred for neonatal extracorporeal membrane oxygenation (ECMO) who had an oxygen index of 20 or greater after treatment with bovine surfactant. Inhaled NO was administered in concentrations from 5 to 80 ppm in random order to 23 infants. Overall, 13 infants had a significant response (an improvement in arterial oxygen pressure > 10 mm Hg or arterial oxygen saturation > 10%) to the first administration of inhaled NO, and one infant had a late response. There was no significant difference in the response to inhaled NO as measured by changes in arterial oxygen pressure or in the alveolar-arterial difference in partial pressure of oxygen, for any of the doses from 5 to 80 ppm. Thirteen infants had echocardiographic evidence of persisted pulmonary hypertension; 11 of these infants responded, compared with 3 responders among the 10 infants without persistent pulmonary hypertension of the newborn (p < 0.01). Overall, 11 infants required ECMO; there were two deaths in this group. Seven infants had congenital diaphragmatic hernia; five of those had a response to NO inhalation and four required ECMO. Our study demonstrates that there is no significant difference in response between low and high doses of inhaled NO and that this treatment may prevent the need for ECMO in some infants referred for this therapy, especially in infants with pulmonary hypertension. Prospective, controlled, randomized, and blinded trials of low doses of inhaled NO are needed to determine the clinical role of this potentially useful therapy.

Administration, Inhalation↗
PubMed1994

An analysis of nursing's performance in the 1992 assessment of research in British universities.

Nursing was rated as lowest of all 72 subjects reviewed in the 1992 assessment of research in British universities. Of the 29 academic nursing departments assessed, 17 received the lowest possible rating and only five were given an average or above average rating. Immediate coverage of these results in the nursing press was slow and superficial, and sometimes misleading. This paper explains how the Research Assessment Exercise (RAE) was carried out. It is argued that academic nursing departments are crucial to the profession in its current pursuit of an improved research capability and productivity and, therefore, that the results of the RAE should be of interest and concern to nurses. The analysis presented of nursing's results shows that the larger, longer-established departments based in research-strong 'old' universities have more research-active staff, and it was these departments that received the best ratings in the RAE. In contrast, most of the nursing departments assigned the lowest possible rating were small, recently established departments in 'new' universities that could not have been expected to distinguish themselves in their first research assessment. It is suggested, however, that any new academic nursing departments should be strategically placed in research-strong universities. Although this paper is concerned with nursing in British universities, the general notion of research funding being allocated on the basis of performance is (or is likely to become) pertinent to other countries, especially those in Europe, North America and Australasia.

Education, Medical↗
PubMed1994

Measuring the costs and quality of palliative care: a discussion paper.

In an era of ever increasing emphasis on cost-effectiveness of health care, and with the introduction of the internal market, there is now an urgent need for information on the costs and quality of palliative care. This paper highlights the complexities involved in acquiring and measuring such information and discusses methods which were tried out in an exploratory study. The study took the form of in-depth case studies in two hospices, one in the voluntary sector and one in the NHS.

Consumer Behavior↗
PubMed1993

Conducting research interviews with elderly people by telephone.

Telephone interviews were employed by nurse researchers as a means of collecting data from elderly people following their discharge from hospital. The paper reviews the literature concerning interviews with elderly patients by telephone and recounts first-hand experience of the method on the basis of over 500 telephone interviews. Although some difficulties were encountered in conducting interviews with the hearing-impaired and the unwell, the method was found to be a cost-effective and useful means of obtaining follow-up data for research purposes. The prime factor in ensuring successful use of the method was the recruitment of subjects via personal interview prior to telephone contact.

Aged↗
PubMed1993

The complexities of using a structure, process and outcome framework: the case of an evaluation of discharge planning for elderly patients.

Effective planning for discharge from hospital of elderly patients is becoming increasingly important as the elderly population rises. Donabedian's structure-process-outcome framework was used for an evaluation of discharge planning at a large teaching hospital. This paper discusses first the difficulties of defining the boundaries between each of the three Donabedian categories, and then makes some suggestions as to what factors require inclusion when considering the structures, processes and outcomes of discharge planning for elderly patients.

Aged↗
PubMed1993

Challenges for nursing research in an era dominated by health service reform and cost containment.

Many health care systems around the world are under reform, not least for reason of necessary cost containment. As one of the largest items of a health service budget, the costs of nursing services are attracting particular attention. This behooves the nursing profession, if only in its own interest, to accumulate convincing evidence of the cost-effectiveness of nursing. Nursing's research track record in the assessment of the costs, quality, and effectiveness of nursing is assessed in this paper and found to be generally weak. The complexity of such research is acknowledged; the need for research which will insure and demonstrate the highest quality of nursing at the lowest possible cost is presented as a key challenge for nurse researchers in the present era.

Cost Control↗
PubMed1992

Neonatal congenital diaphragmatic hernia and extracorporeal membrane oxygenation.

OBJECTIVE: To describe the outcome of infants with congenital diaphragmatic hernia (CDH) presenting early who were referred for possible extracorporeal membrane oxygenation (ECMO). DESIGN: Retrospective descriptive study. SETTING: Neonatal Intensive Care Unit of the Royal Alexandra Hospital, Edmonton. PATIENTS: Fifteen infants referred to our program since its introduction, in February 1989; 13 received ECMO. The criterion for ECMO was the presence of an oxygen index of more than 40 on three occasions within 2 hours. INTERVENTION: ECMO was performed by means of cannulation of the right carotid artery and jugular vein for 111.0 hours on average. RESULTS: In 5 of the 13 infants who underwent ECMO the procedure was performed after surgical repair; all were successfully weaned off ECMO, and the cannula was removed without incident. In the remaining eight ECMO was started before surgical repair; of the six who received it during repair four ultimately survived. None of the previously described predictors of outcome for CDH, including diagnosis before 25 weeks' gestation (in six cases), were useful in determining the survival of the patients. Bleeding was the most common complication and cause of death. CONCLUSION: ECMO is associated with survival in infants with CDH who fail to respond to conventional therapy and who have a poor prognosis according to previously established criteria.

Extracorporeal Membrane Oxygenation↗
PubMed1992

A rare intrapericardial mass in a neonate.

We describe a rare case of a neonate born with an intrapericardial mass composed of extralobar pulmonary sequestration and a cyst of bronchogenic origin. After an uneventful delivery, this full-term newborn was noted to be grunting and indrawing. He remained tachypneic despite adequate management for bilateral pneumothoraces. Diagnostic studies showed a 3 x 3 x 4 cm diameter cystic lesion in the anterior mediastinum causing posterior-lateral displacement of the superior vena cava. The heart itself was structurally normal. Bronchoscopy and esophagoscopy failed to detect any structural abnormalities. At 3 weeks of age, sternotomy and resection of the lesion was performed. The mass was clearly intrapericardial and consisted of sequestrated pulmonary tissue with a unilocular mucus filled bronchogenic cyst. Small systemic tributaries fed the lesion from the posterior-superior aspect. There was no connection with the heart or great vessels. Postoperative recovery was uneventful.

Bronchi↗
PubMed1992

Knowledge, expectations and experiences of patients receiving chemotherapy for breast cancer.

The experiences of a cohort of 60 women receiving chemotherapy in treatment of breast cancer were monitored in an in-depth prospective study. The purpose of the investigation was to identify ways in which nurses could improve the preparation and support of patients undergoing chemotherapy. It was found that patients' knowledge of chemotherapy was limited and that the side-effects they experienced, and their reactions to these, were rather different and more diverse than had been expected. The study illustrates the value of exploring patients' perceptions of their problems and needs for information and support.

Adult↗
PubMed1992

Physiological role of the transient potassium current in the pyloric circuit of the lobster stomatogastric ganglion.

1. Our experiments were performed to assess the quantitative role of the transient potassium current, IA, in determining the cycle frequency and phasing of neurons in the network generating the pyloric motor rhythm in the stomatogastric ganglion of the spiny lobster, Panulirus interruptus. We used 4-aminopyridine (4-AP) to reduce IA and recorded the effects of this treatment on cell activity. 2. In the intact circuit with an actively cycling pyloric rhythm, 4-AP had three major effects on the rhythm. First, the cycle period was decreased approximately 20%. Second, 4-AP enhanced the activity of all cells, causing increases in spikes/burst and spike frequency within bursts. Third, 4-AP altered the phasing of follower cells relative to the onset of the pacemaker (AB/PD) bursts. The lateral pyloric (LP) and pylorics (PYs) were phase advanced by 4-AP, whereas the ventral dilator (VD) was phase delayed. 3. Voltage-clamp studies indicated that pyloric cells differed in the amount of IA they expressed on or near the soma. IA was largest in pyloric dilator (PD) and PY cells, smaller in the anterior burster (AB), LP, and inferior cardiac (IC) cells, and undetectable in the VD cell. When cells were isolated from synaptic input, however, all were excited by 4-AP, suggesting that all possess functionally significant IA. In VD cells, IA-like currents probably occur primarily in nonsomatic cell regions. 4. We measured postinhibitory rebound by determining the delay to the first spike after a series of 200-ms hyperpolarizing prepulses in the PD, PY, LP, VD, and IC cells. In all five cell types, the delay was progressively increased as the potential of the hyperpolarizing prepulse became more negative. This increased delay reflected the removal of IA inactivation. The delay was greatest in the PY cell and least in the IC. In four cells (the PD, PY, LP, and VD) 4-AP decreased the delay to the first spike at all prepulse potentials. In the IC the delay to the first spike was unaffected by 4-AP, suggesting that IA was not responsible for the relatively short delay after hyperpolarizing prepulses. 5. In all five cell types, 4-AP increased the spike frequency for the duration of a 1-s depolarization. The 4-AP-sensitive current responsible for this behavior appears to have very rapid kinetics and may represent a distinct channel subtype. Functionally, this current may act to dampen cell excitability and to reduce spike frequency during bursts.

4-Aminopyridine↗