Comparative toxicity of ammonium and perchlorate to amphibians.
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Animals↗
Biomedical subjects
G Harvey
Publications and source records attributed to G Harvey.
Methods for evaluation of small scale quality improvement projects.
Evaluation is an integral component of quality improvement and there is much to be learned from the evaluation of small scale quality improvement initiatives at a local level. This type of evaluation is useful for a number of different reasons including monitoring the impact of local projects, identifying and dealing with issues as they arise within a project, comparing local projects to draw lessons, and collecting more detailed information as part of a bigger evaluation project. Focused audits and developmental studies can be used for evaluation within projects, while methods such as multiple case studies and process evaluations can be used to draw generalised lessons from local experiences and to provide examples of successful projects. Evaluations of small scale quality improvement projects help those involved in improvement initiatives to optimise their choice of interventions and use of resources. Important information to add to the knowledge base of quality improvement in health care can be derived by undertaking formal evaluation of local projects, particularly in relation to building theory around the processes of implementation and increasing understanding of the complex change processes involved.
Family Practice↗
Ingredients for change: revisiting a conceptual framework.
Finding ways to deliver care based on the best possible evidence remains an ongoing challenge. Further theoretical developments of a conceptual framework are presented which influence the uptake of evidence into practice. A concept analysis has been conducted on the key elements of the framework--evidence, context, and facilitation--leading to refinement of the framework. While these three essential elements remain key to the process of implementation, changes have been made to their constituent sub-elements, enabling the detail of the framework to be revised. The concept analysis has shown that the relationship between the elements and sub-elements and their relative importance need to be better understood when implementing evidence based practice. Increased understanding of these relationships would help staff to plan more effective change strategies. Anecdotal reports suggest that the framework has a good level of validity. It is planned to develop it into a practical tool to aid those involved in planning, implementing, and evaluating the impact of changes in health care.
Delivery of Health Care↗
Progress of unit based quality improvement: an evaluation of a support strategy.
OBJECTIVE: To evaluate a strategy for supporting nurses to work with quality improvement (QI). DESIGN: Post-intervention evaluation. Study participants and intervention: 240 nurses participated in a uniformly designed 4 day basic training course in applying a model for QI. Of these, 156 nurses from over 50 healthcare institutions constituted the generic education (GE) group while 84 nurses from 42 neonatal units took part in a project to develop national guidelines, constituting the targeted intervention (TI) group. METHOD: Postal questionnaire 4 years after the training courses. RESULTS: The response rate was 80% in the TI group and 64% in the GE group. Nurses in the TI group had a significantly higher rate in completing all phases of the QI cycle (p=0.0002). With no differences between the groups, 39% of all nurses were still involved in QI work 4 years after the training courses. Three factors were significantly related to nurses continuing their involvement in QI projects: remaining employed on the same unit (OR 11.3), taking courses in nursing science (OR 4.1), and maintenance of the same QI model (OR 3.1). Reported motives for remaining active in QI work were the enhancement of knowledge, influence over clinical practice, and development as a nurse. Reasons for discontinuation were organisational restructuring, a lack of facilitation and knowledge, and change of workplace. CONCLUSIONS: Participation in a national guideline project, including a common focus for improvement, facilitation and opportunities for networking, seems to have enhanced the ability to carry out the process of QI, but not to sustain the QI work over a longer period.
Guidelines as Topic↗
National guidelines for Swedish neonatal nursing care: evaluation of clinical application.
OBJECTIVE: To evaluate the clinical application of national guidelines for neonatal nursing. DESIGN: Questionnaire survey. SETTING: Thirty-nine neonatal care units in Sweden. STUDY PARTICIPANTS: Thirty-five of 39 nurse managers at all Swedish neonatal care units. INTERVENTION: Thirteen clinical guidelines for neonatal nursing care were presented in 1997. Recommendations on evidence-based nursing care and auditing measures were given. Most neonatal units in Sweden participated in the guideline development. MAIN OUTCOME MEASURES: Extent of guideline application, ways in which the guidelines were used and perceived usefulness. RESULTS: The guidelines were applied to different extents in 30 of the 35 units. Almost all the guidelines were applied, especially those covering general nursing care. In total, 72 Quality Improvement (QI) projects were reported, of which 51 concerned specific topics covered in the guidelines. Twenty units applied the guidelines as a starting point for QI. Four units evaluated nursing practice against the guidelines. Four factors [Dynamic Standard Setting System (DySSSy) as the QI method, > or = 4 years of practice as nurse manager, experience of nursing research, and good staff resources] were closely related to a more extensive application of the guidelines. Units with both a nurse manager and an assistant nurse manager were more likely to have used the guidelines as the basis for changing clinical practice. CONCLUSIONS: The guidelines were successfully disseminated and diffused, but practitioner involvement in guideline development did not guarantee implementation. Downsizing, leadership and facilitation seemed to be crucial factors when getting evidence into practice. Limited occurrence of evaluations of clinical practice against guideline recommendations suggests a need for valid and user-friendly measures.
Attitude of Health Personnel↗
Seven habits of highly effective school nurses
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Journal Article↗
Towards practice development--a vision in reality or a reality without vision?
This paper describes the development of a conceptual framework for practice development. Drawing on the authors' combined experiences of facilitating developments in practice, a conceptual framework is proposed. It is argued that much practice development in health care today lacks a systematic approach and is often undertaken by individual practitioners who are poorly prepared for their roles. A short history of practice development is outlined to contextualize current development activities. The proposed framework is located in a critical social science philosophy and it is suggested that such a philosophy enables individual growth and development, empowerment of practitioners and the generation of cultural change that sustains continuous growth and innovation in practice. An example of the framework in use is described and recommendations proposed to enable organizations to embrace a systematic approach to practice development.
Clinical Competence↗
Multiplex polymerase chain reaction for the simultaneous detection of Mycoplasma pneumoniae, Chlamydia pneumoniae, and Chlamydia psittaci in respiratory samples.
AIMS: To develop a multiplex polymerase chain reaction (PCR) for the simultaneous detection of Mycoplasma pneumoniae, Chlamydia pneumoniae, and Chlamydia psittaci in respiratory samples. METHODS: Oligonucleotide primers for the amplification of the DNA of these three organisms were optimised for use in combination in the same reaction. PCR products were detected by hybridisation with pooled internal probes using an enzyme linked immunosorbent assay. Those with positive signals were further differentiated using species specific probes. Quality of DNA extraction and PCR inhibition were controlled by amplification of a human mitochondrial gene. A panel of 53 respiratory samples with known results was evaluated blindly. This was followed by a retrospective study on sputa collected from 244 patients with suspected community acquired pneumonia. RESULTS: The multiplex assay had a lower sensitivity than PCR with individual primers by about one log. The resultant sensitivity was considered acceptable for diagnostic use. Of the panel of 53 samples, nine of 11 M pneumoniae, 11 of 11 C pneumoniae, six of seven C psittaci, and 24 of 24 negative samples were correctly identified. Of the 244 patients with pneumonia, seven (2.9%) had detectable M pneumoniae, six (2.5%) had C pneumoniae, and one (0.4%) had C psittaci. The case notes from 11 patients were studied. The PCR finding was of possible significance in at least eight of these patients. CONCLUSIONS: This multiplex PCR assay has the potential to be used as a diagnostic and epidemiological tool. Further prospective studies are needed to establish its clinical value.
Adolescent↗
Obturator neuropathy. An anatomic perspective.
Entrapment of the anterior division of the obturator nerve is a recently described cause of medial groin pain. This anatomic study examines the extrapelvic course of the nerve and related fascia in the adductor region to provide an anatomic basis for the syndrome and to aid in surgical treatment. Twelve anatomic specimen limbs were dissected to document the extrapelvic course of the obturator nerve, the myofascial arrangement, and the vasculature. A thirteenth limb was prepared with intraarterial glycerin to examine the vessels in more detail. A distinct fascial plane was found deep to the adductor longus and pectineus overlying the anterior division of the obturator nerve. The arterial supply to the adductor muscles is related intimately to the nerve and its branches, with associated local thickening of the fascial connective tissue. The relationship between the nerve, vessels, and fascia appears sufficient to result in an entrapment syndrome. The anatomic findings from this series will help plan the surgical treatment of this condition.
Cadaver↗
Enabling the implementation of evidence based practice: a conceptual framework.
The argument put forward in this paper is that successful implementation of research into practice is a function of the interplay of three core elements--the level and nature of the evidence, the context or environment into which the research is to be placed, and the method or way in which the process is facilitated. It also proposes that because current research is inconclusive as to which of these elements is most important in successful implementation they all should have equal standing. This is contrary to the often implicit assumptions currently being generated within the clinical effectiveness agenda where the level and rigour of the evidence seems to be the most important factor for consideration. The paper offers a conceptual framework that considers this imbalance, showing how it might work in clarifying some of the theoretical positions and as a checklist for staff to assess what they need to do to successfully implement research into practice.
Evidence-Based Medicine↗
School nurse web authoring.
Many school nurses are now surfing the World Wide Web for clinical and professional information. The Web is also a tool for providing professional services and delivering nursing care. Three applications for school nursing are featured: using the Web for professional publishing, a state association web page, and a school nurse office website.
Authorship↗
Four cases of aggressive MRSA wound infection following head and neck surgery.
Four cases of serious MRSA wound infection following head and neck surgery have been identified. One patient died. At post mortem a mediastinal abscess containing MRSA was found to have eroded into the innominate artery causing fatal haemorrhage. The other three suffered serious wound infections, two requiring further surgery. Once MRSA had been identified they were treated with intravenous teicoplanin and all made a full recovery.
Adult↗
Practitioner based quality improvement: a review of the Royal College of Nursing's dynamic standard setting system.
OBJECTIVE: To explore and describe the implementation of the Royal College of Nursing's approach to audit--the dynamic standard setting system--within the current context of health care, in particular to focus on how the system has developed since its inception in the 1980s as a method for uniprofessional and multiprofessional audit. DESIGN: Qualitative design with semistructure interviews and field visits. SETTING: 28 sites throughout the United Kingdom that use the dynamic standard setting system. SUBJECTS: Quality and audit coordinators with a responsibility for implementing the system; clinical staff who practice the system. MAIN MEASURES: Experiences of the dynamic standard setting system, including reasons for selection, methods of implementation, and observed outcomes. RESULTS: Issues relating to four themes emerged from the data: practical experiences of the system as a method for improving patient care; issues of facilitation and training; strategic issues of implementation; and the use of the system as a method for multiprofessional audit. The development of clinical practice was described as a major benefit of the system and evidence of improved patient care was apparent. However, difficulties were experienced in motivating staff and finding time for audit, which in part related to the current format of the system and the level of training and support available for clinical staff. Diverse experiences were reported in the extent to which the system had been integrated at a strategic level of quality improvement and its successful application to multiprofessional clinical audit. CONCLUSIONS: The Royal College of Nursing's dynamic standard setting system can successfully be used as a method for clinical audit at both a uniprofessional and multiprofessional level. However, to capitalise on the strengths of the system, several issues need to be considered further. These include modifications to the system itself, as well as a more strategic focus on resources and support for audit, better integration of quality initiatives in health care, and a continuing focus on ways to achieve true multiprofessional collaboration and involvement of patients in clinical audit.
Evaluation Studies as Topic↗
Characterization of antinucleolar antibody reactivity in patients with systemic sclerosis and their relatives.
OBJECTIVE: To study the prevalence and specificity of antinucleolar antibodies (ANoA) in patients with systemic sclerosis (SSc), their spouses, and their first-degree relatives, and to investigate whether SSc family members have greater frequency of ANoA than expected. METHODS: The sera of 58 SSc probands, 4 first-degree relatives with SSc, 215 first-degree relatives without SSc, and 24 spouses were screened for ANoA by indirect immunofluorescence (IF), and nucleolar antigens were characterized by immunoprecipitation (IP) of 35S methionine labeled K562 cell extracts. Sera from 118 randomly chosen family members without SSc were separately compared with 120 age and sex matched blood donor controls. RESULTS: Antinucleolar reactivity was detected by IF in 25 patients with SSc (40.3%), in 33 non-SSc relatives (15.3%), and in 4 spouses (16.7%). Twenty-four sera had autoantibodies to defined nucleolar antigens by IP (seven Pm-Scl, ten RNA polymerase (pol) I, four U3 RNP, three Th RNP), and all were from patients with SSc (38.7%). No serum had more than one type of nucleolar-specific autoantibody. Four sera had autoantibodies to topoisomerase I (topo I) and RNA pol II, one of which also recognized RNA pol I and RNA pol III. Antinucleolar IF was significantly more common in the unaffected first-degree relatives of patients with SSc (18.1%) than in controls (8.3%; p < 0.05). A small number of sera from both relatives and controls recognized bands by IP, none of which was identified as a SSc-specific autoantigen. CONCLUSION: Although antinucleolar reactivity is more common in the first-degree relatives of patients with SSc than controls, SSc associated ANoA are only present in patients with the disease, and appear to be mutually exclusive.
Antibodies, Antinuclear↗
Post-exposure prophylaxis after needlestick injuries would require change in management.
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HIV Infections↗
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↗
Quality in health care: traditions, influences and future directions.
In tracing developments in health care quality, a number of different approaches to quality evaluation can be identified, differing in terms of the specific focus and means of achieving quality. This paper attempts to classify the development of quality in health care, drawing on experiences within the industrial quality movement. Three distinct models of quality evaluation are described, according to whether they define quality at an individual level, as an exercise in inspection, or as a method for continuous improvement. Developments in quality and audit in health care are explored in relation to the models and specific experiences within nursing and medicine are compared. The need to be aware of the history of quality within specific professional groups is highlighted, particularly within the context of future developments in health care quality and the growing focus on multi-professional collaboration.
Forecasting↗