Generating enthusiasm for nursing research.
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Attitude of Health Personnel↗
Biomedical subjects
Christine Wilson
Publications and source records attributed to Christine Wilson.
Graft failure following allogeneic blood and marrow transplant: evidence-based nursing case study review.
Despite the advances made since the earliest days of transplant therapy, graft failure following allogeneic blood and marrow transplant is still a life-threatening complication. This article reviews the science of graft failure and uses a case study presentation to address how an oncology nursing staff was motivated by a patient's experience of graft failure. An evidence-based literature review was undertaken to answer three relevant clinical questions: (a) What factors contribute to graft failure in patients receiving allogeneic hematopoietic stem cell transplants? (b) What interventions are appropriate for these patients? and (c) How can this information assist nursing staff in providing improved care for these patients? An example of the table of evidence is provided.
Adult↗
Pathogen growth in herbal teas used in clinical settings: a possible source of nosocomial infection?
In some clinical settings, herbal tea is used in patient care (eg, for oral hygiene). Teabags containing herbal tea were therefore tested with regard to the presence of microbial contamination before and after brewing. In addition, pathogen growth in intentionally contaminated brewed tea was investigated over time. Teabags and brewed tea were highly contaminated (maximum mean values of 1.9 x 10(8) CFU/g raw tea), and it was found that the pathogen load of intentionally contaminated tea increased significantly (by a maximum of 10(5) colony-forming units/mL brewed tea) over time, suggesting a possible risk of patients developing a nosocomial infection when used in patient care.
Bacteria↗
The ambitions of adolescents born with exstrophy: a structured survey.
OBJECTIVE: To determine the factors that control quality of life as perceived by adolescent patients with bladder exstrophy, and to compare their views using standard instruments. PATIENTS AND METHODS: Sixteen patients (mean age 19 years, range 16-21, 11 male and five female) were recruited from the departmental database; they represented 46% of those available for the study. After giving informed consent, each had a semi-structured interview, augmented by completing a self-reported scale, with the principal investigator. They then completed the Culture-Free Self-Esteem Inventory-2 (CFSEI-2) and the Brief Symptom Inventory (BSI). The interviews were recorded on audiocassette, transcribed verbatim and evaluated using interpretative phenomenological analysis. RESULTS: In the interviews there was a remarkable consistency in the domains identified as important to the patients. There was a wish to be normal and to be treated as such. This was defined (amongst other items) as being able to void with an appropriate noise, being treated as peers at school and at home, and having an umbilicus. All patients reported some bullying (all but one in the past), but only severely in three. Concerns about self-image centred on scars and genital appearance. Very similar and effective coping strategies had been created, including practical (e.g. suitable clothes) and emotional (e.g. joking, control of revealed information) aspects. Special arrangements made to help (care by a special assistant or use of a disabled lavatory at school) served only to emphasize their abnormality and were resented. No overt psychiatric or psychological morbidity was detected. There was no difference in scores with the CFSEI-2 or BSI from established age-related norms. CONCLUSION: This study confirms the anecdotally reported strong resilience and personality of adolescents with exstrophy. The domains that patients considered important were not those that their carers might have expected or that are used in standard quality-of-life instruments. No morbidity was identified by the two instruments used. In exstrophy, and perhaps in other uncommon conditions, the patients' views of relevant domains should be considered in assessing quality of life.
Adaptation, Psychological↗
Weight change, body image, and quality of life in HIV disease: a pilot study.
Fat distribution alterations and lipodystrophy occur as part of a broad spectrum of body alterations in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). Recent advances in HIV therapies, including highly active antiretroviral therapy, contribute to these fat distribution alterations. The purpose of this pilot study was to investigate the relationships of weight change, body image, length of time with HIV/AIDS diagnosis, and quality of life in HIV disease. The sample consisted of 23 men with mean age of 42.2 years (SD = 8.2) and 17 women with mean age of 36.8 years (SD = 5.2). Participants reported a net increase in weight from 3 months prior (M = 2.4 lb, SD = 12.9 lb) and 12 months prior (M = 10.9 lb, SD = 19.1 lb). They also reported that their weight was greater than their ideal weight (M = 9.2 lb, SD = 22.9 lb). Body image scores (0-100 scale) were found to be significantly (F((1, 37)) = 5.41, p = .03) higher for women (73.1 +/- 17.0) compared with men (60.2 +/- 17.0). Although HIV-positive participants had slightly higher body image scores (M = 68.0, SD = 17.0) compared with participants with AIDS (M = 60.5, SD = 18.8), there was no significant difference (F((1, 37)) = 1.56, p = .22) in body image scores between those with HIV and those with AIDS. Finally, weight change was related to three scales of the Medical Outcomes Study-HIV: mental health (r = .42, p = .03), vitality (r = .53, p = .006), and quality of life (r = .45, p = .02) for men. There were no significant correlations between weight change and quality of life domains for women. Education of clinicians and individuals living with HIV/AIDS should focus on the assessment, management, and evaluation of weight change during the course of HIV disease.
Adult↗
Cognitive function in people with chronic illness: inflammatory bowel disease and irritable bowel syndrome.
Recent research has shown that people with chronic illnesses often experience cognitive deficits, such deficits may be specific to a particular type of illness, reflecting the disease process itself, or they may be deficits that are common across a number of chronic illnesses. Our study investigated whether people with an organic disease (Inflammatory Bowel Disease) show cognitive dysfunction relative to the control group and people with a functional illness (Irritable Bowel Syndrome), and if so, to elucidate the mechanisms by which such dysfunction occurs. A quasi-experimental design using three groups of participants provided scores on IQ, memory, and cognitive flexibility. Differences in absolute scores were slight. However, a noticeable interaction effect was found between group and IQ: The illness groups showed a deficit in verbal IQ relative to both their own performance IQ and to that of the control group's verbal IQ. This verbal deficit cannot be explained by depression, cognitive load, or medication.
Adult↗
Histochemical, immunohistological and scanning electron microscope analysis of tissue retained on spontaneously extruded ventilation tubes.
The aim of this study was to analyse the tissue surrounding prematurely extruded ventilation tubes (grommets). Thirty-one ventilation tubes, including 21 Shah and six Shepherd tubes, that had been extruded naturally into the ear canal were examined. After formalin fixation, material adhering to the tubes was retrieved and processed to paraffin wax. Five tubes were processed for scanning electron microscope (SEM) analysis. Sections were stained using histochemical methods for collagen, keratin and keratohyaline. In addition, the presence of collagen (type I and III), keratin, vimentin, fibronectin, tenascin, factor VIII-related antigen, CD31 and CD45 was tested for by immunohistochemistry. Results showed that all specimens consisted of an acellular fibrous material, oriented in concentric rings parallel to the tube surface that was often associated with small collections of CD45+ inflammatory cells. Two specimens contained collagen that was detectable by histochemical and immunohistological methods. Twelve specimens contained identifiable desquamated epithelial cells containing keratin and keratohyaline. Only one specimen stained positively for connective tissue markers (vimentin, fibrous fibronectin, tenascin) or showed the presence of vascular epithelium. SEM revealed adherent clusters or sheets of plate-like structures, consistent with the presence of epithelial squames, on three of the five ventilation tubes examined. It is concluded that tissue retained on extruded grommets consists of orthokeratinitizing epithelium infiltrated by inflammatory cells, a finding that is consistent with the theory that tube extrusion occurs as a result of squamous epithelial proliferation, medial migration, differentiation and desquamation.
Biomarkers↗
Change in physiotherapy management of children with cystic fibrosis in a large urban hospital.
A retrospective audit was conducted in 1998 and 2000 to review the physiotherapy management of hospitalized children with cystic fibrosis (CF) at the Brisbane Royal Children's Hospital (RCH). The objective was to detect and explore possible changes in patient management in this time period and investigate whether these changes reflected changes in the current theory of CF management. All children over two years of age with CF admitted during 1998 and 2000 with pulmonary manifestation and who satisfied set criteria were included (n = 249). Relative frequency of each of six treatment modalities used were examined on two occasions, revealing some degree of change in practice reflecting the changes in current theory. There was a significant decrease in the frequency of usage of postural drainage with head-down tilt (p < 0.001), and autogenic drainage (p < 0.001) between 1998 and 2000. Modified postural drainage without head-down tilt (p < 0.001), and positive expiratory pressure devices (p < 0.001) were used more frequently in 2000 (p < 0.001). No significant changes were identified in the use of Flutter VRP1 (p = 0.145) and exercise (p = 0.763). No significant differences were found in population demographics or occurrence of concomitant factors that may influence patient management.
Adolescent↗
Respiratory exacerbations in children with cystic fibrosis: physiotherapy treatment outcomes.
Treatment efficacy is crucial in cystic fibrosis (CF) as it impacts directly upon life expectancy, with its evaluation contributing to the evidence base for physiotherapy practice. This study assesses whether respiratory outcomes changed at the Royal Children's Hospital, Brisbane (RCH) over a period when physiotherapy airways clearance techniques altered All 1998 and 2000 admissions of children over two years of age to RCH for CF related respiratory exacerbations were included, totalling 248 admissions, 125 in 1998 and 123 in 2000. Data for respiratory effort, cough quality, sputum volume/weight, sputum colour and sputum stickiness were analysed. Respiratory function test (RFT) results included: forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and forced expiratory flow (FEF25-75%) and % of predicted values. Repeated measures ANOVA and appropriate post hoc tests evaluated changes occurring during the admissions. Independent-samples t-tests allowed comparison of the improvement in the two years. During hospital admission in both 1998 and 2000, a significant improvement in RFT results occurred. Similar improvements in 1998 and 2000 suggested no change in treatment efficacy had occurred. Significant changes during hospitalisation, in cough quality, sputum volume/weight, and sputum colour suggest that these variables are appropriate and simple physiotherapy outcome measures.
Adolescent↗
Stress response syndromes in women undergoing mammography: a comparison of women with and without a history of breast cancer.
OBJECTIVE: The purpose of this study was to assess the incidence, severity, and correlates of acute stress responses in women undergoing diagnostic mammographic surveillance and to explore the moderating impact of physician support on these symptoms. METHODS: Sixty-six female breast cancer outpatients (at least 12 months after diagnosis and primary treatment) and 69 healthy women undergoing mammographic surveillance completed measures of: acute stress response, somatization, trauma history, psychiatric history, social support, and physician satisfaction. RESULTS: Previous cancer, pre-mammography breast complaints, lower income, previous psychiatric medication use, greater instrumental support, greater somatization, greater perceived physician disengagement, and less perceived physician support were all associated with increased stress responses. Among women with a previous cancer diagnosis, those with greater distress reported higher levels of physician support. In contrast, among those without a previous cancer diagnosis, those with greater perceived physician support reported less distress. CONCLUSIONS: These findings suggest that cancer-related cues, such as follow-up surveillance, may trigger a sensitizing response in women with a previous cancer diagnosis. The association of distress with physician support may arise from the responsiveness of physicians to identified distress, from increased help-seeking behavior by those who are distressed, or both. The benefit of support provided by health care professionals to those at risk of developing stress response syndromes deserves further study.
Acute Disease↗
Introducing generic workers to the care of spinal cord injury.
The generic worker role extends the HCA role in spinal cord injury care. The development of the generic worker role took place at the Midland's Centre for Spinal Injuries (MCSI) in order to implement a number of government policies. There remains room for improvement, development and audit of the role.
Career Mobility↗