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Biomedical subjects

A M Walsh

Publications and source records attributed to A M Walsh.

13 recordsLinked to original sources
PubMed2001

Improving pain management by nurses: A pilot Peer Intervention Program.

Significant pain continues to be reported by many hospitalized patients despite the numerous and varied educational programs developed and implemented to improve pain management. A theoretically based Peer Intervention Program was designed from a predictive model to address nurses' beliefs, attitudes, subjective norms, self-efficacy, perceived control and intentions in the management of pain with p.r.n. (as required) narcotic analgesia. The pilot study of this program utilized a quasi-experimental pre-post test design with a patient intervention, nurse and patient intervention and control conditions consisting of 24, 18 and 19 nurses, respectively. One week after the intervention, significant differences were found between the nurse and patient condition and the two other conditions in beliefs, self-efficacy, perceived control, positive trend in attitudes, subjective norms and intentions. The most positive aspects of the program were supportive interactive discussions with peers and an awareness and understanding of beliefs and attitudes and their roles in behavior.

Adult↗
PubMed2001

Determinants of nurses' intention to administer opioids for pain relief.

A statewide cross-sectional survey was conducted in Australia to identify the determinants of registered nurses' intention to administer opioids to patients with pain. Attitudes, subjective norms and perceived control, the key determinants of the Theory of Planned Behavior, were found to independently predict nurses' intention to administer opioids to these patients. Perceived control was the strongest predictor. Nurses reported positive overall attitudes towards opioids and their use in pain management. However, many negative attitudes were identified; for example, administering the least amount of opioid and encouraging patients to have non-opioids rather than opioids for pain relief. The findings related to specific attitudes and normative pressures provide insight into registered nurses' management of pain for hospitalized patients and the direction for educational interventions to improve registered nurses' administration of opioids for pain management.

Attitude of Health Personnel↗
PubMed2001

Fever management practises: what pediatric nurses say.

Pediatric nurses manage fevers in hospitalized children daily: a complex practise. The present study identified varied decision-making criteria and inconsistent practise influenced by many external variables. Nurses perform comprehensive assessments in order to make informed decisions. However, factors influencing their practise include medical orders, the temperament of the child, a history of febrile convulsions, parental requests, colleagues and ward norms. Nurses have a 'temperature' at which they consider a child febrile (37.2-39.0 degrees C) and many reported a 'temperature' at which they administered antipyretics (37.5-39.0 degrees C). Antipyretics were administered to febrile children for pain relief, irritability, at the request of parents and to settle a child for the night. Administration was reported to be higher during the day and evening shifts, at medication rounds and when the ward was busy. At night, nurses were reluctant to wake a sleeping febrile child, preferring to observe them instead. Recommendations to promote consistent fever management practises are included.

Analgesics, Non-Narcotic↗
PubMed1999

Cross-gender mentoring and career development in the health care industry.

Career development in the next century will be predicated upon the ability to forge hierarchical as well as lateral relationships. This study of 223 managers in the health care industry found that mentors influenced the career mobility of female executives and ensured access to promotions within the organization.

Adult↗
PubMed1998

Quantitation of bacteria in blood of typhoid fever patients and relationship between counts and clinical features, transmissibility, and antibiotic resistance.

Salmonella typhi was isolated from 369 and Salmonella paratyphi A was isolated from 6 of 515 Vietnamese patients with suspected enteric fever. Compared with conventional broth culture of blood, direct plating of the buffy coat had a diagnostic sensitivity of 99.5% (95% confidence interval [CI], 97.1 to 100%). Blood bacterial counts were estimated by the pour plate method. The median S. typhi count in blood was 1 CFU/ml (range, <0.3 to 387 CFU/ml), of which a mean of 63% (95% CI, 58 to 67%) were intracellular. The mean number of bacteria per infected leukocyte was 1.3 (interquartile range [IQR], 0.7 to 2.4) CFU/cell (n = 81). Children (< 15 years old; n = 115) had higher median blood bacterial counts than adults (n = 262): 1.5 (range, <0.3 to 387) versus 0.6 (range, <0.3 to 17.7) CFU/ml (P = 0.008), and patients who excreted S. typhi in feces had higher bacteremias than those who did not: a median of 3 (range, <0.3 to 32) versus 1 (range, <0.3 to 68) CFU/ml (P = 0.02). Blood bacterial counts declined with increasing duration of illness (P = 0.002) and were higher in infections caused by multidrug-resistant S. typhi (1.3 [range, <0.3 to 387] CFU/ml; n = 313) than in infections caused by antibiotic-sensitive S. typhi (0.5 [range, <0.3 to 32] CFU/ml; n = 62) (P = 0.006). In a multivariate analysis this proved to be an independent association, suggesting a relationship between antibiotic resistance and virulence in S. typhi.

Adolescent↗
PubMed1998

Positioning for capitation in long-term care: a profile of vertical integration strategies in health and social service organizations.

During the next decade, the population over age 65 is expected to increase by 11% while the population over age 85 is expected to increase by 42%. These projections suggest that many organizations which currently provide services to the aged will be required to design a range of new products and services for this diverse population. Vertically integrated services provide a viable opportunity to competitively position an organization to respond to the diverse needs of an aged market. Since vertical integration will be essential in negotiating capitate contracts for the aged in the future, this study examined the extent of vertical integration in 116 health and social service organizations in an urban market with an expanding geriatric population.

Aged↗
PubMed1987

Cysts of Tenon's capsule following filtration surgery. Medical management.

Cysts of Tenon's capsule (encapsulated blebs) developed postoperatively in 77 (13%) of 607 eyes that underwent filtration surgery between 1980 and mid-1985. The annual incidence was not uniform, increasing markedly throughout the period. Seventy-four eyes were treated with medical therapy only. At a mean follow-up of 19 months, the success rate for these eyes, defined as an intraocular pressure (IOP) of 21 mm Hg or less, was 92%. The three eyes that underwent surgical revision subsequently failed clinically by the study criteria. Those patients in whom cysts of Tenon's capsule developed were compared with an age-matched control group to assess for possible differences in long-term outcome. There was a significantly higher IOP in the Tenon's cyst group at one and three months after surgery, and an increased proportion of IOPs above 30 and 40 mm Hg. At a six-month and later follow-up, there was no significant difference in the mean IOP or in progression of visual field loss. Causative factors were sought for the development of these cysts of Tenon's capsule. Prior conjunctival surgery, or previous cyst formation in the other eye, were the significant risk factors noted.

Adolescent↗
PubMed1987

Impact of DRG reimbursement: implications for intervention.

Despite the multiplicity of factors which contributed to the surge in health expenditures, federal policy to resolve this dilemma has focused on cost containment strategies. In particular, the Tax Equity and Fiscal Responsibility Act which spawned the DRG system, has been acclaimed as a success in containing hospital costs. Further analysis suggests that costs may not have declined significantly, but may have been absorbed in other sectors of the health care industry. Conversely, qualitative factors which influence patient care and concomitant costs may have been omitted from governmental data. Systems intervention to illuminate these discrepancies and insure humane care for the elderly are proposed for social workers in the health care system.

Aged↗
PubMed1985

Binding studies of SV40 T-antigen to SV40 binding site II.

SV40 T-Antigen binding site II was synthesized, cloned and analyzed for its ability to bind purified SV40 T-antigen. We report the binding constant of T-antigen for isolated site II. Using a filter binding assay the calculated binding constant was 6-8 fold less efficient than site I previously reported. Binding constants were calculated using two methods. The first was a direct calculation using a protein titration curve (KD). The second was by the ratio of measured association and dissociation rates. Both methods gave similar constants. Protection studies with SV40 T-antigen on the T-antigen binding sites in the wild-type array demonstrated that the binding constants of site I and site II are similar to those calculated for the individual sites. These results demonstrate that SV40 T-antigen does not bind cooperatively to sites one and two as earlier believed and are in agreement with recent observations emanating from several laboratories.

Antigens, Polyomavirus Transforming↗
PubMedDate not supplied

Managing environmental uncertainty: an analysis of executive behavior in the health and social service sector.

Executives who are involved in a variety of professional associations may be in a more favorable position to manage environmental uncertainty because of their ability to access information through the informal network. This study examined the professional involvement of 116 executives in the health and social service sector and found that leadership status within a professional association influenced contractual agreements between executives and a regional area agency on aging.

Administrative Personnel↗
PubMedDate not supplied

Mentoring in health administration: the critical link in executive development.

Career development in the next century will be predicated on the ability to forge hierarchical as well as lateral relationships within diverse organizational environments. Mentoring relationships may provide the critical link for future health executives to remain involved in their organization and their profession. This national study of 540 healthcare managers examined the prevalence of mentoring relationships according to demographic, organizational, and professional variables. Mentors appeared to influence access to promotional opportunities for managers in the healthcare industry and provide a mechanism for executive development.

Adult↗