Biomedical subjects
Publications and source records attributed to E J Pugh.
This article reviews the role of endoscopic biliary stents in palliative care. In particular it focuses on the indications for stents, and recognition and management of possible complications. These issues are illustrated with three case reports.
OBJECTIVE: To determine whether parenteral penicillin given before admission to hospital reduces the case fatality rate in patients with meningococcal disease. DESIGN: Retrospective analysis of 46 consecutive patients admitted to hospital with meningococcal disease from January 1986 to March 1991. SETTING: District general hospital. MAIN OUTCOME MEASURE: Hospital case fatality rate. RESULTS: None of the 13 patients given parenteral penicillin by the referring doctor before admission died, compared with eight deaths (24%) in 33 patients admitted without such treatment. CONCLUSION: Parenteral penicillin given before admission probably contributed to a reduction in the case fatality rate from meningococcal disease, and primary care physicians should be encouraged to give such treatment immediately on suspicion of the diagnosis before transferring the patient to hospital. Public health physicians are well placed to inform and alert general practitioners of the potential benefit of this action.
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A census of waiting lists in five surgical specialties within the Northern Region has been carried out. In addition to enumerating those patients waiting for inpatient treatment and outpatient consultation, the census characterized lists in terms of the age and sex structure of those waiting; the length of time people had waited; their district of residence and (for inpatients only) the numbers waiting for certain specified operations or procedures. Patients waiting for inpatient treatment were older, overall, than the general population and, within specialties, ophthalmology lists contained a higher proportion of the very elderly whilst ear, nose and throat surgery lists had a younger age-structure. Three-quarters of ophthalmology inpatient lists were made up of patients waiting for cataract surgery, 14 per cent of patients awaiting orthopaedic inpatient treatment were waiting for hip joint replacement and 32 per cent of gynaecology lists comprised women needing sterilization. These data on age-structure and case composition are broadly similar to recent work carried out by Yates's group who restricted their study to longer waiting lists in the West Midlands Region and Wales. When data in the present study were related to the population from which the cases arose, it was found that the prevalence of outpatient waiting was greater than inpatient waiting except for general surgery (where a higher proportion of the population was awaiting inpatient treatment) and in gynaecology (where outpatient and inpatient waiting was equally common).2+ Standardized waiting list ratios (SWLRs) have been calculated to allow comparisons between districts and specialties, free of distortions produced by differing age-structure of populations.(ABSTRACT TRUNCATED AT 250 WORDS)
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Families of clients under the care of the probation service are at significantly higher risk of experiencing a cot death or a stillbirth than the general public. Pregnant women in the immediate families of clients under the care of the probation service should be identified to health service personnel involved in their antenatal and postnatal care in an effort to avert unnecessary deaths.
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The case study, although associated with several misconceptions which compromise its effective utilization, is especially appropriate for investigation of clinical nursing problems. A literature review of the application of this research approach in other practice-based disciplines was completed. Results indicate that the case study permits focusing upon the individual in an intensive, longitudinal perspective, and facilitates bridging of the research-practice gap. Internal and external validity, considered especially problematic in case studies, can be maximized by a variety of techniques.
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Observation of behavior to study clinical teaching provides advantages over the use of questionnaires alone. The great advantage is the richness of the data. Problems encountered in the process, e.g., gaining access to subjects in multiple institutions, selecting non-volunteer subjects, obtaining informed consent in a manner which will not bias the data, becoming unobtrusive and non-threatening to subjects, coping with the unpredictability of the clinical setting, and staying in the role of researcher in spite of temptations to enact other roles within the setting, are all foreseeable and to some degree preventable. Being aware of the potential obstacles permits the investigator to plan for them and to be less emotionally aroused as each new problem arises. Other nurse researchers are encouraged to utilize these techniques; the experience can be not only valuable in terms of realistic data obtained, but also can be an extremely rewarding experience.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A statewide survey of nurses in perinatal centers was conducted to assess the prevalence of do-not-resuscitate (DNR) policies in neonatal intensive care units (NICUs) and to examine factors influencing nurses in those centers in their compliance with DNR orders. Three nurses in each of 10 perinatal centers were asked to complete a questionnaire on DNR policies and nurses' compliance and to respond to four hypothetical clinical situations. Eighteen of the 27 responding nurses reported the existence of a DNR policy. Factors affecting compliance with DNR orders were agreement that the infant should not be resuscitated (n = 24) or respect for the parents' wishes (n = 19). Nurses' intention to resuscitate despite a DNR order varied, depending on the description of the infant. Multiple regression analyses showed that subjective norms (beta = .41 to .82) rather than attitudes (beta = .17 to .39) exerted a more powerful influence on nurses' decisions not to resuscitate.