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Biomedical subjects

E Drake

Publications and source records attributed to E Drake.

10 recordsLinked to original sources
PubMed2006

Obstetric regional blocks for women with multiple sclerosis: a survey of UK experience.

BACKGROUND: There has been a reluctance to use regional blocks for women with multiple sclerosis as effects on the course of the disease are unclear. We assessed the views of UK consultant obstetric anaesthetists regarding management of women with multiple sclerosis. METHODS: Following Obstetric Anaesthetists' Association approval a questionnaire was sent to UK consultant members. Opinions were sought on antenatal assessment, labour analgesia, anaesthesia for elective and emergency caesarean section, and modification in technique for those with multiple sclerosis. Enquiries were made of postnatal problems ascribed to regional blocks. RESULTS: Of the 592 replies analysed, 91% of respondents had seen fewer than 10 cases of multiple sclerosis in the past 10 years. Antenatal assessment was recommended by many with postnatal relapse most commonly discussed (64%). Many highlighted the need for informed consent and minimising local anaesthetic dose. For labour analgesia 79% would perform a regional block; a further 20% would do so in certain circumstances. For elective caesarean section, epidural rather than spinal anaesthesia was preferred by 4%; 2% would not use a regional block, preferring general anaesthesia. For emergency caesarean section with time only for single-shot spinal, 3% would give a general anaesthetic. Deterioration of symptoms after delivery were reported by 20% with 3% attributing symptoms such as prolonged block, leg weakness, bladder dysfunction and postnatal relapse to regional blocks. CONCLUSION: Most UK anaesthetists would perform regional blocks for labour and caesarean section in multiple sclerosis, although the experience of each anaesthetist is limited. Many emphasised the need for thorough pre-assessment and informed consent.

Adult↗
PubMed1999

A patient decision aid regarding antithrombotic therapy for stroke prevention in atrial fibrillation: a randomized controlled trial.

CONTEXT: Decision aids are tools designed to help patients participate in the clinical decision-making process. OBJECTIVE: To determine whether use of an audiobooklet (AB) decision aid explaining the results of a clinical trial affected the decision-making process of study participants. DESIGN: Randomized controlled trial conducted from May 1997 to April 1998. SETTING: Fourteen centers that participated in the Stroke Prevention in Atrial Fibrillation (SPAF) III trial. PARTICIPANTS: A total of 287 patients from the SPAF III aspirin cohort study, in which patients with atrial fibrillation and a relatively low risk of stroke received 325 mg/d of aspirin and were followed up for a mean of 2 years. INTERVENTION: At the end of SPAF III, participants were randomized to be informed of the study results with usual care plus use of an AB (AB group) vs usual care alone (control group). The AB included pertinent information to help patients decide whether to continue taking aspirin or switch to warfarin. MAIN OUTCOME MEASURES: Patients' ability to make choices regarding antithrombotic therapy, and 6-month adherence to these decisions. Their knowledge, expectations, decisional conflict (the amount of uncertainty about the course of action to take), and satisfaction with the decision-making process were also measured. RESULTS: More patients in the AB group made a choice about antithrombotic therapy than in the control group (99% vs 94%; P = .02). Patients in the AB group were more knowledgeable and had more realistic expectations about the risk of stroke and hemorrhage (in the AB group, 53%-80% correctly estimated different risks; in the control group, 16%-28% gave correct estimates). Decisional conflict and satisfaction were similar for the 2 groups. After 6 months, a similar percentage of patients were still taking their initial choice of antithrombotic therapy (95% vs 93%; P = .44). CONCLUSIONS: For patients with atrial fibrillation who had participated in a major clinical trial, the use of an AB decision aid improved their understanding of the benefits and risks associated with different treatment options and helped them make definitive choices about which therapy to take. Further studies are necessary to evaluate the acceptability and impact of decision aids in other clinical settings.

Aged↗
PubMed1998

A decision aid for women considering hormone therapy after menopause: decision support framework and evaluation.

Although postmenopausal women are advised to consider their values when deliberating about potential benefits and risks of hormone therapy (HRT), feasible, effective methods of decision support in primary care have yet to be established. Using an explicit decision support framework, we developed a self-administered HRT decision aid and evaluated it in a before/after study of 94 women from six family practices. An audiotape guided women through an illustrated booklet including: detailed information about HRT benefits and risks tailored to a woman's clinical risk, and a values clarification exercise to promote informed decision making consistent with personal values. After using the decision aid participants: had better general knowledge and more realistic personal expectations of HRT benefits and risks; and, felt more certain, informed, clear about values, and supported in decision making. Women's values elicited in the clarification exercise were 84% accurate in discriminating between decisions. Women with polarized preferences at baseline did not change their minds, but were better informed. Changes in preferences occurred in the uncertain group, with equal numbers accepting or declining HRT. Most participants found the decision aid comprehensible, acceptable in length and pace, and balanced. Decision aids are useful in preparing women for decision making about this complex, personal issue.

Aged↗
PubMed1995

Discharge teaching needs of parents in the NICU.

Teaching parents how to care for their infant in the NICU can be a challenge. This study investigated card sort as a teaching aid. Proposed by many investigators to improve the effectiveness of nurses' teaching interventions, card sort is based on Q-technique, once used in research, now adapted as a teaching tool. Card sort involves parents in sorting out topics of information according to their own priorities. A pilot study was designed to test this method in the NICU. Ten parents and seven nurses participated in this trial. The parents were asked to sort a set of 17 colorful 5 x 7 inch cards into three piles (from least important to most important); each card was labeled with a discharge teaching topic. The nurses working with these parents also sorted the cards, and their responses were compared to those of the parents. Although parents' and nurses' discharge teaching priorities differed, both groups ranked CPR and signs and symptoms of illness as priorities. There are many advantages of the card sort method in relation to adult learning and social cognition theory. Parents are clearly the best source for determining their own teaching needs, and card sort is a useful tool that involves parents in discharge teaching through self-assessment of needs.

Adult↗
PubMed1985

Reconstructive hand surgery for quadriplegic persons.

Reconstructive hand surgery is one approach to restoring lost hand function in quadriplegic patients. This paper describes Craig Hospital's experience with the two-stage procedure for achieving active grasp and pinch for C7 spinal cord-injured patients. It describes the hand clinic, patient selection and education, the surgery itself, and postsurgical occupational therapy. It also includes follow-up results on all patients treated since the program's inception.

Activities of Daily Living↗
PubMed1983

Assay of urinary oxalate: six methodologies compared.

To assess how well results by different methods for urinary oxalate determinations agree with each other in a clinical setting, we compared six different assays: Hodgkinson and Williams (Clin Chim Acta 36:127-132, 1972), enzymatic, modified Hodgkinson and Williams, gas chromatography, ion chromatography, and "high-pressure" liquid chromatography. For the entire group of samples, the mean value by each method agreed relatively closely, although the enzymatic procedure produced a somewhat higher value. All six methods had large coefficients of variation within (8-58%) and between (15-88%) assays. In addition, analytical recovery by most assays was more than 100% of the added oxalate. Analytical recovery of 10 micrograms of oxalate added per milliliter of urine specimen ranged from 86 to 237%; for 20 micrograms/mL it was 83 to 320%. Thus for the six methods evaluated, no single method appeared to be superior to the others.

Chromatography, Gas↗
PubMedDate not supplied

Internet technology: resources for perinatal nurses.

The Internet and the World Wide Web (WWW) are being discussed in many forums. This huge body of information is becoming a widely used research tool. Within the last few years, the WWW has grown enormously. In 1993, there were approximately 130 WWW sites. By 1997, experts estimated there were over a million sites on the web, many of them useful for nurses and accessible from the nearest computer. For perinatal nurses in practice, research, or education the need for information is great. Nurses need current data for clinical decision making, policy writing, patient education, continuing education, and research. Understanding how to use the Internet, being aware of its advantages and disadvantages, and knowing how to critically examine what is available will assist perinatal nurses in making use of this newest form of information technology.

Humans↗
PubMedDate not supplied

Randomized trial of a portable, self-administered decision aid for postmenopausal women considering long-term preventive hormone therapy.

Although practice guidelines suggest that postmenopausal women learn about the benefits and risks and consider their values when deciding about hormone therapy, the optimal decision-support method has not been established. In a randomized controlled trial, the authors compared the efficacy of a general educational pamphlet with that of a tailored decision aid. The pamphlet briefly summarized benefits, risks, and likely beneficiaries in general terms. The decision aid, delivered via booklet and audiotape, provided: detailed benefits and risks using functional terms and probabilities tailored to clinical risk; and steps for considering the issue in a woman's own situation, including a value-clarification exercise. Compared with the pamphlet group, the decision-aid group had statistically significant (p < 0.05) improvements in terms of realistic personal expectations of the benefits and risks, decisional conflict, and perceived acceptability of the intervention. Levels of general knowledge about the main benefits and risks were comparable for the two interventions. It is concluded that tailored decision aids prepare women for decision making better than do general pamphlets.

Aged↗