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Biomedical subjects

Cecily Begley

Publications and source records attributed to Cecily Begley.

5 recordsLinked to original sources
PubMed2006

Prehospital care pathway delays: gender and myocardial infarction.

AIM: This paper reports the findings of a study that identified gender specific prehospital care pathway delays amongst Irish women and men with myocardial infarction. BACKGROUND: Women are more likely to experience a poorer prognosis than their male counterparts following hospitalization for myocardial infarction, yet research shows that women continue to experience prehospital care pathway delays. METHODS: A 1-year prospective census was carried in six major academic teaching hospitals in Dublin, Ireland in 2001-2002. A total of 277 (31%) female and 613 (69%) male patients with confirmed myocardial infarction were included in the study. RESULTS: Women were more likely to experience prolonged 'initial symptom-onset to A&E delays' (14 hours vs. 2.8 hours P < 0.0001), and 'intense symptom-onset to A&E delays' (3.1 hours vs. 1.8 hours , P < 0.0001), i.e. arrival at a hospital accident and emergency department. Advancing age was associated with greater prehospital delays (P < 0.0001), whilst patients with private health insurance had shorter delays than public patients (without private health insurance) or those with medical cards (entitling them to means-tested medical benefits) (P = 0.001). Patients who drove themselves by car to hospital had shorter median prehospital times than those arriving by any other admission mode (P < 0.0001), whilst those referred by their general practitioner had longer delays than those who were self-referred (5 hours vs. 1.7 hours, P < 0.0001). CONCLUSIONS: Female gender, advancing age, referral source, insurance status and mode of transport to hospital are independent factors contributing to prehospital patient delays. Nurses who care for patients with coronary artery disease have a unique opportunity to educate people about the most appropriate action to be taken in the event of experiencing symptoms.

Age Factors↗
PubMed2006

Fetal anomaly screening: what do women want to know?

AIM: This paper reports a study exploring women's experiences of receiving an adverse diagnosis at a routine second trimester ultrasound examination, and the factors that influenced their preparedness for an adverse finding. BACKGROUND: Ultrasound has become a routine part of prenatal care offered to pregnant women in most developed countries and technological advances are making it increasingly possible to detect more anomalies, and at earlier gestations. When fetal anomaly detection can be an outcome of the examination, provision of effective information to ensure informed consent for screening remains a challenge. METHOD: A grounded theory study (n = 38) was carried out in 2004 and 2005 using an in-depth interview within 4 weeks of diagnosis and constant comparative analysis. FINDINGS: The core category of balancing information emerged, whereby women balanced the expectation of a healthy baby and the non-threatening nature of the ultrasound examination with the shock of an adverse diagnosis. Assumed fetal health was contributed to by being in good health, experiencing normal symptoms of pregnancy and having other healthy children. The majority of women believed that provision of extensive and detailed lists regarding fetal anomaly detection would only cause unnecessary anxiety and worry, and suggested that a less detailed approach is required for a routine screening programme for low-risk pregnancy. CONCLUSION: The drive to inform all women fully of ultrasound detection rates for specific anomalies may be counter-productive as it will enhance the worry pregnant women already feel in relation to the health of their unborn baby.

Adaptation, Psychological↗
PubMed2006

The Community Client Need Classification System - a dependency system for community nurses.

AIM: The aim of this paper was to discuss the predictive validity and reliability of the Community Client Need Classification System (CCNCS), the results of using this tool and public health nurses' satisfaction with the system. BACKGROUND: Public health nurses provide the majority of community nursing services in Ireland. The traditional method of measuring workload in the community is based on recording the number of visits. The revised Easley-Storfjell instrument for Caseload/Workload Analysis was modified for the Irish context and permission from the authors was sought to use it in this study and was thus named the CCNCS. METHODS: A convenience sample of 29 public health nurses used the CCNCS to classify 1352 clients for 2 weeks. RESULTS: The elderly and child health groups accounted for the majority of the nurses' direct and indirect time. Predictive validity analysis demonstrated a positive relationship between needs level and nursing time. Nurses reported that the CCNCS was useful in predicting the needs of new and existing clients. CONCLUSIONS: This classification system, albeit in the first draft of its revised form, was perceived by the chosen sample of public health nurses as useful in measuring their workload. Further research is required to ascertain the reliability of the modified classification system with a larger sample size.

Activities of Daily Living↗
PubMed2005

In-hospital care pathway delays: gender and myocardial infarction.

AIM: This paper reports the in-hospital findings of a study identifying gender specific care pathway delays or treatment opportunities amongst Irish women and men hospitalized with myocardial infarction. BACKGROUND: Reperfusion therapy is of optimum benefit when administered early, yet research shows that women continue to experience greater in-hospital delays to treatment than men. METHOD: A 1-year prospective census was carried out from December 2001 to November 2002 with 277 (31%) female and 613 (69%) male patients with myocardial infarction who were consecutively admitted to the six major teaching hospitals in Dublin, Ireland. RESULTS: Women experienced greater 'Triage to first medical assessment' delays than men (P=0.001), and waited a median of 30 minutes for their first medical contact, compared with 20 minutes for men (P<0.0001). The median 'door to needle' time for women was 70 minutes in comparison with 52 minutes for men (P=0.02). Women waited longer than men for aspirin (P=0.02), whilst men received a bed in the coronary care unit almost 1 hour sooner than women (P<0.0001). Despite these delays to treatment, women and men experienced similar rates of reperfusion treatment. CONCLUSIONS: In-hospital treatment delays experienced by women may limit their potential to achieve the maximum benefits from reperfusion therapies. Triage nursing provides the first entry point to hospital care for the majority of female patients with myocardial infarction, and therefore Accident and Emergency Department nurses are in an optimum position to influence positively the pathway of care for this group.

Angioplasty, Balloon, Coronary↗