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G Harvey

Publications and source records attributed to G Harvey.

At least 19 recordsLinked to original sources
PubMed1996

Achieving improvement through quality: an evaluation of key factors in the implementation process.

Quality, audit and standard setting are major issues on the present day nursing and health care agenda. Considerable time, energy and resources have been invested in developing and implementing a range of different quality and audit systems, yet there is limited evidence to date to suggest that they are having any significant impact in terms of changing practice and improving patient care. This paper will present the results of a study undertaken to evaluate the implementation of three of the most common nursing quality systems used in the United Kingdom: Monitor, Qualpacs and the dynamic standard setting system (DySSSy). In each case, the focus was on identifying key factors in the process of implementation that could predict positive programme outcomes--defined in terms of acceptance by clinical nursing staff and perceived impact on the quality of patient care. The study adopted a three-stage evaluation design, with three distinct levels of investigation and analysis, and utilized a range of descriptive and exploratory methods. In total, 14 sites implementing one of the three nursing quality systems were studied. Additional data, derived from individuals' experiences of implementing quality in nursing, were used to enhance and validate the findings. The results indicated a number of important system-related, contextual and practical issues of implementation. These were underpinned by two key factors, defined as ownership for quality and action to improve. However, most present day nursing quality programmes appear to be failing to embrace these two concepts simultaneously. The paper will conclude by discussing the implications of these findings for future developments in nursing and health care quality improvement.

Attitude of Health Personnel↗
PubMed1996

From research to practice: one organizational model for promoting research-based practice.

This paper describes a framework used by the National Institute for Nursing in Oxford to integrate research, development and practice. With the increasing attention given to the topic of how research findings are implemented into clinical practice, it was felt important to share the challenges that have arisen in attempting to combine traditional research activities with more practice-based development work. The emerging conceptual framework, structures and functions are described, highlighting the variety of partnerships to be established in order to achieve the goal of integrating research into practice. While the underpinning principles of the framework-generating knowledge, implementing research into practice and evaluating the effectiveness of programmes-are not new, it is the way they have been combined within an organizational structure that could be helpful to others considering such a strategy. Both the strengths and weaknesses of the framework are discussed, a number of conclusions drawn as to its robustness and consideration given to its replication.

Diffusion of Innovation↗
PubMed1995

The high vaginal swab in general practice: clinical correlates of possible pathogens.

Clinical features, diagnosis and treatment of 286 women whose high vaginal swabs (HVS) submitted by their general practitioners showed pure, heavy growth of Staphylococcus aureus, beta haemolytic streptococci groups A, C or G, Streptococcus milleri, Streptococcus pneumoniae or Haemophilus influenzae were analysed. Women with group A, C and G streptococci frequently had clinical vulvovaginitis and although the numbers were too small for statistical confirmation, S. pneumoniae and H. influenzae appeared to cause clinical disease as well. The association of S. aureus or S. milleri with clinical vulvovaginitis was much less convincing. It seems relevant for laboratories to report sensitivities for group A, C and G streptococci. Further research is needed to determine the pathogenicity of S. pneumoniae and H. influenzae.

Adolescent↗
PubMed1995

Quality improvement of nursing care in hospitals in India: the dynamic approach.

A workshop was held in Calcutta in August 1992 by the Nurses' Research Society of India (NRSI), in partnership with the Royal College of Nursing of the UK, Dynamic Quality Improvement Programme (DQIP), to introduce an approach to quality improvement to nurses in India interested in evaluating and improving the care they provide. Since then, three sites have implemented the system for standard setting and audit (Dynamic Standard Setting System) which is the method for evaluating care used within that approach. An appraisal of the progress of the sites to date indicates that, in the clinical setting, nurses are progressing well with the writing of standards and have experienced little difficulty in understanding the theory and processes involved. They are currently revising the standards written with a view to implementing them and auditing them in the near future. This article outlines the introduction of dynamic quality improvement and the Dynamic Standard Setting System to the nurses in India and describes the progress of one of the test-sites currently working on its implementation.

Group Processes↗
PubMed1995

Protein binding and serum bactericidal activities of vancomycin and teicoplanin.

In a randomized crossover study, the protein binding and serum bactericidal activities (SBAs) of vancomycin and teicoplanin against Staphylococcus aureus and Streptococcus pyogenes were investigated in six healthy volunteers. Total concentrations in serum 1 h postadministration of vancomycin and teicoplanin were 25.5 +/- 2.7 and 10.8 +/- 8.9 mg/liter, respectively; mean free concentrations were 14.6 +/- 2.0 and 0.6 +/- 0.9 mg/liter, respectively. Protein binding for vancomycin was 36.9% +/- 2.87%, and that for teicoplanin was 97.4% +/- 2.6%. SBA determined in pooled human serum at 1 h against S. aureus ranged from 1:8 to 1:32 for both vancomycin and teicoplanin. Against S. pyogenes SBA at 1 h ranged from 1:16 to 1:128 for vancomycin and 1:256 to 1:2,048 for teicoplanin. In vitro kill curve studies showed that vancomycin is slowly bactericidal and that teicoplanin is bacteriostatic. Despite having less in vitro cidal activity against the study isolates and having low or unrecordable levels of free drug in serum, teicoplanin demonstrated a similar or better SBA than vancomycin. SBA was more closely related to the total drug level (r = 0.77 for S. aureus and r = 0.79 for S. pyogenes) than the free level of teicoplanin (r = 0.59 for S. aureus and r = 0.56 for S. pyogenes). The high level of protein binding of teicoplanin did not seem to impair its antibacterial activity as measured by its SBA.

Adult↗
PubMed1994

Anti-topoisomerase I antibodies in silica-associated systemic sclerosis. A model for autoimmunity.

OBJECTIVE: To determine the frequency and type of autoantibodies present in patients with systemic sclerosis (SSc) associated with an established environmental toxin. METHODS: Clinical data and sera were available from 14 men with silica-associated SSc who had developed SSc after at least 2 years of exposure to silica at work. Controls included 27 men with silicosis without SSc. Autoantibodies were measured by immunodiffusion, immunoblotting, and functional inhibition of topoisomerase I (topo I). RESULTS: Nine of the 14 patients with silica-associated SSc had anti-topo I antibodies. All anti-topo I antibodies in the patients with silica-associated SSc and in 14 anti-topo I-positive patients with idiopathic SSc were directed at an active site of topo I, or at least sterically inhibited its function. One patient with silica-associated SSc had anticentromere antibodies. Unexpectedly, 2 patients with silicosis who had no symptoms of a connective tissue disease had autoantibodies to Ro/SS-A and La/SS-B autoantigens. CONCLUSION: Anti-topo I antibodies are the predominant autoantibodies present in silica-associated SSc. The generation of anti-topo I antibodies in genetically susceptible individuals may depend partly on the patient's sex and on the site of organ involvement, and may be triggered by silica particles acting as an immune adjuvant.

Aged↗
PubMed1994

HLA-DQB1 associations with anti-topoisomerase-1 antibodies in patients with systemic sclerosis and their first degree relatives. United Kingdom Systemic Sclerosis Study Group.

The frequency and functional properties of anti-topoisomerase-1 antibodies (ATA) have been studied in 58 systemic sclerosis (SSc) probands, 218 first degree relatives and 22 spouses. The dependence of ATA on the presence of certain HLA-DRB1 and HLA-DQB1 alleles was examined. ATA were detected by immunodiffusion, by absorption or inhibition of topoisomerase-1 enzymic activity, by immunoblotting of a K562 cell extract and by immunoprecipitation of 35S radiolabelled cell lines. HLA class II typing for HLA-DRB1 and HLA-DQB1 was performed by oligonucleotide typing in 49 families. Six probands and two relatives had ATA. The relatives with ATA had SSc. All eight individuals with ATA directly inhibited topoisomerase-1 function. Four of the eight had limited skin disease and four had diffuse skin involvement. The seven who were genotyped had at least one HLA-DQB1 allele encoding for tyrosine at position 30 of the first domain. Therefore, ATA are not widely dispersed within families, but rather are only present in those with SSc, and certain genetic requirements appear necessary for their generation.

Alleles↗
PubMed1994

Criteria formulation and application: an evaluative framework.

This paper critically examines how criteria are formulated and applied in quality assurance or quality improvement systems. It begins by drawing attention to the division that exists between criteria derived by so-called expert groups and those developed more locally by practitioners. In seeking to analyse the strengths and weaknesses of these two contrasting approaches, it explores the more fundamental questions of how criteria are formulated in general and how they can best be applied. An evaluative framework is offered as a working checklist for practitioners involved in criteria formulation. The framework identifies three main areas: actual construction of criteria; procedures for formulation and issues related to application. An example of each area is offered from results of the ODySSSy Project. The paper concludes by recommending more systematic studies in this highly complex area.

Delphi Technique↗
PubMed1994

Cutaneous cryptococcal infection without immunodeficiency.

A case of cutaneous cryptococcosis (encapsulated strain) in a 67-year-old female, with no evidence of immune suppression (normal cell surface marker analysis and mitogen proliferation studies) and which responded to treatment with oral fluconazole is reported. To date her clinical progress remains satisfactory after 12 months of follow-up.

Aged↗
PubMed1994

Penetration of amoxycillin/clavulanic acid into bronchial mucosa with different dosing regimens.

BACKGROUND: The efficacy of an antibiotic is related to its concentration at the site of infection. Previous studies of the concentrations of amoxycillin and clavulanic acid (co-amoxiclav) in respiratory secretions or whole lung tissue have suffered from methodological problems. The concentration of amoxycillin and clavulanic acid was determined in bronchial mucosal biopsy samples obtained at bronchoscopy following five different dosing regimens. METHODS: Bronchial biopsy and serum samples were obtained from 50 patients undergoing diagnostic bronchoscopy. Ten patients each received 375 mg, 625 mg, 750 mg, and 3.25 g oral, and 1.2 g intravenous co-amoxiclav 1-3 hours before bronchoscopy. The concentrations of clavulanic acid and amoxycillin were determined by high performance liquid chromatography using a microbore column, solid phase extraction, and preconcentration to improve sensitivity tenfold over previous methods. RESULTS: Concentrations of both clavulanic acid and amoxycillin in bronchial mucosa were dose related and were well above the MIC90 of co-amoxiclav for the common bacterial respiratory pathogens including Haemophilus influenzae, Micrococcus catarrhalis and Streptococcus pneumoniae for all dosing regimens. Mean mucosal levels were 200% and 118% of the corresponding serum levels for amoxycillin and clavulanic acid respectively. CONCLUSIONS: Amoxycillin and clavulanic acid are concentrated in bronchial mucosa and, even at the lowest dose of 375 mg orally, are likely to produce tissue levels in the lung sufficient to inhibit all the common community acquired respiratory pathogens.

Amoxicillin↗
PubMed1993

A comparison of expert- and practitioner-derived criteria for post-operative pain management.

A comparison of two methods of criteria formulation was carried out as part of a 3-year research study looking at the effectiveness of a nursing quality assurance system (the Royal College of Nursing's Dynamic Standard Setting System). In particular, the study wished to explore whether and to what extent criteria sets derived from an expert group differed from criteria generated by local practitioner groups. One expert group and five local groups were helped to develop criteria on the topic of post-operative pain management. Results showed that the expert group underwent a much more controlled and systematic approach to the task than any of the local groups who were supported by newly trained facilitators. Despite this difference, two of the five local groups had criteria convergence scores of more than 55%, demonstrating that the local knowledge on the topic was acceptable. Whether the lower convergence of the groups was due to lack of knowledge or a combination of difficult group processes and novice facilitation is difficult to say. However, what the study did show was that local groups can generate criteria sets comparable to expert groups, given proper facilitation and support.

Adult↗
PubMed1993

Connective tissue disease and autoantibodies in the kindreds of 63 patients with systemic sclerosis. The United Kingdom Systemic Sclerosis Study Group.

Systemic sclerosis (SSc) tends to occur in a sporadic fashion and familial occurrence of the disease is unusual. Nevertheless, reports of related connective tissue diseases (CTD), autoantibodies, or both in family members together with associations of certain HLA class II phenotypes with SSc suggest that genetic factors might play a part in susceptibility to the disease. Because of the relative rarity of SSc only a small number of family pedigrees have been studied previously. This report represents the largest study to date, to our knowledge, of family members of patients with scleroderma, and provides the opportunity to investigate the relative importance of genetic and environmental factors operating in the disease. The family pedigrees of 63 patients with systemic sclerosis were examined with respect to clinical, serologic, and immunogenetic features. Multiple cases of SSc were seen only in 1 family, in which the disease affected a father and daughter. Disease expression in these 2 individuals was very similar both clinically and serologically; relatives with other connective tissue diseases were found in 9 families, and nonspecific features of CTD such as Raynaud phenomenon, and arthralgia or arthritis, occurred commonly, especially in female relatives. Antinuclear antibodies (ANA) were also detected more frequently in relatives than in controls. However, antibodies previously demonstrated to have a high degree of specificity for SSc were confined to patients with this disease. Probands had an increase in the frequency of HLA-DR3, DR5, and C4AQO. Patients with diffuse scleroderma had an increased frequency of HLA-DR3, while those with the limited form of the disease had an increased frequency of HLA-DR5.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Aztreonam selective agar for gram positive bacteria.

Aztreonam blood agar, a new selective medium for Gram positive aerobic bacteria, was evaluated in comparison with conventional media for skin swabs. Aztreonam agar increased the number of isolates of Staphylococcus aureus by 17%. By producing purer growths on primary isolation, it significantly speeded up the identification and sensitivity testing of staphylococci and streptococci. All major Gram positive aerobic pathogens grow on this medium. Aztreonam agar is now an established addition to our culture media. It is used for swabs which are likely to have a mixed Gram positive and Gram negative flora, such as ears, burns, ulcers, and for the sputa of patients with cystic fibrosis.

Agar↗
PubMed1992

Clinical panel assessment of photodamaged skin treated with isotretinoin using photographs.

BACKGROUND AND DESIGN: Evaluation of the treatment of photodamaged skin requires adequate efficacy criteria. This study tested the ability of five independent dermatologists to distinguish the effect of topical treatment with isotretinoin cream (0.05% for 3 months, then 0.1% for 6 months) in 326 patients compared with vehicle for 9 months in 325 patients using high-quality, reproducible photographic slides. Panelists were blinded to the patient's identity, treatment group, and time of the photograph (baseline or end of treatment). A computer randomly projected the baseline photograph to one side of a split screen and the end-of-treatment photograph to the other. OBSERVATIONS: Isotretinoin was significantly better than vehicle for overall appearance, fine wrinkles, and discrete pigmentation by multivariate analysis of the combined results for all panelists. Univariate analysis for each panelist also indicated statistically significant superiority of isotretinoin over vehicle for overall appearance (four panelists), fine wrinkles (five panelists), and discrete pigmentation (three panelists). CONCLUSION: The clinical panel detected significantly better improvement in photodamaged-skin treated with isotretinoin than in such skin treated with vehicle. The panel provided an independent assessment of the effects of treatment uninfluenced by physical findings during treatment or information provided by the patients treated.

Humans↗
PubMed1991

Ionic binding, adaptive resistance and post-antibiotic effect of netilmicin and ciprofloxacin.

Ionic binding, post-antibiotic effect (PAE) and adaptive resistance to netilmicin and ciprofloxacin were investigated in 11 distinct clinical isolates. Both netilmicin and ciprofloxacin showed concentration dependent kill and PAE when bacteria were exposed to these antibiotics at 37 degrees C. The effects of netilmicin were maintained at 4 degrees C, when there is no energy dependent cell uptake of antibiotic, but were partially inhibited by exposure to NaCl and EDTA although not by Ca++. This supports the concept that ionic binding to the bacterial cell wall is important in the initial uptake of netilmicin. Ciprofloxacin showed no such effects at 4 degrees C. Adaptive resistance (reduced bacterial kill on second exposure) occurred with both netilmicin and ciprofloxacin but was seen more frequently with netilmicin. It persisted longer than classical PAE but, even after continuous exposure, was not enough to suggest a loss of kill with a twice daily dosing regimen of netilmicin or ciprofloxacin.

Ciprofloxacin↗
PubMed1991

An evaluation of approaches to assessing the quality of nursing care using (predetermined) quality assurance tools.

This paper examines the implementation of four of the most common approaches to nursing quality assurance in England, namely Monitor, Qualpacs, nursing audits and a patient satisfaction questionnaire entitled 'What the Patient Thinks'. The primary aim of the study was to look more closely at the context, processes and outcomes of selecting and implementing specific quality assurance tools. Data were analysed at three distinct levels. The findings are presented around the structure of this three-level framework and indicate that the process of implementing a quality assurance tool is more important than the tool itself. It is suggested that a bottom-up approach to implementation, which locates ownership and control of the quality assurance tool with practitioners, is seen to result in more favourable staff responses and positive programme outcomes. The implementation of Qualpacs is used to illustrate some of the tensions that can occur between the inherent principles of the tool and the method of implementation. In studying the factors that might influence the method of implementing a quality assurance tool, a number of organizational and managerial factors are identified.

Attitude of Health Personnel↗