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Biomedical subjects

I Holloway

Publications and source records attributed to I Holloway.

At least 19 recordsLinked to original sources
PubMed2005

Chronic pain as perceived by older people: a qualitative study.

BACKGROUND: the practical issues confronting older people who suffer chronic pain may not be tackled in a pain clinic setting and little is known of their strategies for coping. They seem to have little or no information on how to improve the quality of their lives or on resources available to them. AIM: the aim of this study was to ascertain from older people the practical, physical and psychosocial limitations they faced because of chronic pain, and the strategies they used to deal with them. METHOD: a qualitative approach to generating data was chosen using a Grounded Theory approach and unstructured interviews. Sixty-three people ranging from 60 to 87 years of age participated in the study. Audio-tapes were transcribed verbatim. The material was coded and collapsed into themes. RESULTS: two main themes emerged: (i) the desire for independence and control; and (ii) adaptation to a life with chronic pain. The valuing of independence is in line with previous findings. With only three exceptions none of the participants were certain how or where to get help with practical issues and so they lived in fear of loss of their independence. Several sub-categories formed the theme of adaptation. These were acceptance and non-acceptance, pacing oneself, helping other people, the use of prayer and 'looking good and feeling good'. When independence and control is effective, older people may adapt better to chronic pain. CONCLUSION: understanding chronic pain sufferers from their own perspective may have important clinical implications. The interview data informed the development of a booklet designed to meet the needs of older patients with chronic pain.

Adaptation, Psychological↗
PubMed2004

Increased presence of cells with multiple elongated processes in osteoarthritic femoral head cartilage.

OBJECTIVE: This study examined the morphology of chondrocytes in articular cartilage from osteoarthritic (OA) and non-OA human femoral heads and in particular the appearance of a sub-population of cells with multiple elongated processes radiating up to 30 microm into the extracellular matrix. METHODS: Cartilage explants were removed from 8 anatomical sites over the surface of OA (n=6) and non-OA (n=5) femoral heads. Cells were labeled for vimentin intermediate filaments and visualized using epi-fluorescence and confocal microscopy. The percentage of cells with elongated processes was correlated with macroscopic and histological indicators of osteoarthritis. RESULTS: Cells with processes accounted for less than 10% of the total cell population in non-OA cartilage. By contrast, in the peripheral regions of the OA femoral head these cells accounted for 20-45% of the total cell population, the differences being statistically significant. These peripheral areas are habitually non-load bearing and were also the most likely to show gross fibrillation and pannus formation. A statistically significant correlation was demonstrated between the percentage of cells with processes and the histological extent of the OA degradation, quantified in terms of the Mankin score. CONCLUSIONS: The extension of cell processes, which may be associated with localized breakdown of the pericellular matrix, will undoubtedly alter numerous aspects of cell function including phenotypic expression and mechanotransduction. Hence these significant changes in chondrocyte morphology are likely to have important implications for the aetiology of osteoarthritis and the development of potential treatment strategies.

Cartilage, Articular↗
PubMed2001

Brain injury: the uncertainties of using complementary therapies.

The use of complementary therapies is fast growing in the UK, but their place within health care is still unclear. This study explored the views of families using a specific complementary therapy in the care of their brain-injured children, and of professionals involved in the care of the children. The findings revealed an interesting comparison of views about the use of complementary therapies and attitudes towards their use.

Adolescent↗
PubMed2001

The impact of recent primary care reforms in the UK on interprofessional working in primary care centres.

This study comprises the perspectives of professionals in primary care regarding the impact of the changes in its organisation and interprofessional collaboration in the UK. General practitioners (GPs), nurses and practice managers were interviewed in three primary cares located within a 20-mile radius and in the same health authority. Interviews were analysed using the grounded theory approach of Glaser & Strauss (1967) as developed by Strauss & Corbin (1998). The separate ideologies and subcultures of GPs, nurses and managers influenced their perceptions of reforms in primary care. Professional identities and the traditional power structure generated some conflict between the three groups which affected collaboration in implementing the reforms. Based on the findings of the study, it seems probable that it will take a new generation of health professionals to bring about an interprofessional culture in the NHS.

Communication Barriers↗
PubMed2000

Fitting in: maintaining a sense of self during hospitalisation.

In this study the patients' perspective of 'fitting in' was gained through participant observation and interviews. Eleven patients' stories confirmed that while hospitalisation can alleviate the suffering caused by illness, it may cause distress. In order to minimise this threat to self patients adjust to hospital life. They are supported by family, friends and health professionals in interpreting the social rules of the ward by conforming to, circumventing and challenging them.

Adaptation, Psychological↗
PubMed1999

'Practice professional development plans': general practitioners' perspectives on proposed changes in general practice education.

BACKGROUND: The Chief Medical Officer has presented a report proposing a change in general practitioners' education towards a 'Practice Professional Development Plan', which, in principle, is based around formal needs assessment, practice-based learning in areas identified by those involved, and with the potential for multi-professional learning. This aims to replace the present system of a financial allowance earned by attending a certain amount of educational activity. AIM: To study the opinions of a group of general practitioners attending a course that included workshops that introduced and considered this educational initiative. METHOD: Semi-structured interviews four weeks after the course. RESULTS: Educational benefits were clearly seen, while issues such as funding and time will present difficulties in implementation. CONCLUSIONS: This proposal was seen as an improvement to the existing postgraduate educational allowance system. To maintain enthusiasm, successful introduction will depend on the issues of support and resources.

Adult↗
PubMed1998

Experiences and career intentions of general practice registrars from The Netherlands.

For some years prospective general practitioners (GPs) from the Netherlands have come to Britain to complete their training. Not all report enjoying their time here, and many leave this country after training. The aim of this study was to examine reasons for coming to Britain, experiences, perceptions and career intentions. The sample consisted of 14 general practice registrars working in their practice year in Southern England. Data were collected through in-depth semistructured interviews and analysed by thematic qualitative analysis. The main reasons for training in this country were easier access, a quicker route to specialization and the quality of training provided. Most had positive professional and personal experiences and saw the British system of training GPs as up to date and supportive of their educational and professional needs. They highlighted some of the positive aspects of the British system, such as the emphasis on teamwork and collaboration with other primary care professionals. They did, however, point out problems and conflicts; for instance, they saw the health care system in Britain as more bureaucratic and as providing unequal access for different groups of the population. Despite their fear of litigation, which they saw as one of the drawbacks for British general practitioners, most looked favourably on the option of staying in or returning to this country if possible. All registrars valued their stay in Britain; however, personal circumstances often dictated a return to Holland. Our findings have implications for manpower planning and recruitment for general practice in both Britain and Holland.

Attitude of Health Personnel↗
PubMed1998

Learners' experience of continuing medical education events: a qualitative study of GP principals in Dorset.

BACKGROUND: General practitioners' (GPs') attendance at continuing medical education (CME) events has increased since the introduction of the Post Graduate Educational Allowance (PGEA) in 1990. However, few studies have examined doctors' perceptions about their continuing education, and explored their views in depth. AIM: To investigate general practitioners' experience of CME events, what personal impact they had, and how the GPs perceived the influence of CME in their professional practice and patient care. METHOD: A qualitative study, with in-depth semi-structured interviews, of a purposive sample of 25 general practitioners in Dorset was conducted. Content analysis was used to identify major themes from the transcripts. RESULTS: GPs perceived CME events as beneficial. Confidence levels rose, and the events provided a break from practice that refreshed and relaxed, thus indirectly benefiting patients. The opportunities provided by formal events for informal learning and exchange of ideas, with both peers in general practice and consultant colleagues, were highly valued. The relevance of the subject to general practice, and the appropriateness of the educational format, were considered of paramount importance. Few responders identified major changes in their practice as a result of formal CME events, and information was seldom disseminated among practice colleagues. CONCLUSION: The results of this study challenge GP educators to provide CME that is relevant, to recognize the value of peer contact, and to facilitate the incorporation of new information into practice.

Data Collection↗
PubMed1997

Fibrolamellar hepatocellular carcinoma: results of partial liver resection.

AIM: To assess the results of partial hepatic resection in the treatment of fibrolamellar hepatocellular carcinoma. PATIENTS AND RESULTS: We present six cases of Fibrolamellar hepatocellular carcinoma treated by partial hepatic resection. There were five females and one male with a mean age of 20 (2.6) yr. Five patients were stage IVA and 1 IVB based on the Union International Against Cancer Classification. Two patients, due to recurrent disease, needed further pulmonary resection and a hilar lymphadenectomy. All six cases underwent major resection, three with vascular reconstruction. No operative mortality was recorded; half of the patients displayed some degree of morbidity. One patient died six months after the operation and the rest are alive at 78, 41, 24, 12 and 9 months. We believe that even in advanced cases, an aggressive surgical policy even with vascular reconstruction is justified in patients with fibrolamellar hepatocellular carcinoma.

Adolescent↗
PubMed1996

Nurses' perceptions of staff appraisal.

The aim of this study was to explore the perspectives of qualified nurses on the implementation of staff appraisal. The sample consisted of eight nurses, varying in age, professional status and experience, within the clinical area in a hospital located in the South of England. Each participant was interviewed in depth. The unstructured interviews were then transcribed, coded and analysed in line with the strategies of grounded theory. The data yielded several important factors which require consideration by senior nurses and managers if they are to execute appraisals effectively. Contrary to expectations, the majority of participants expected, and even eagerly anticipated, the implementation of appraisals. However, several informants expressed concern that appraisals may be used against them. 'Gaining direction and purpose' was seen by staff as the main benefit of the appraisal from a personal and organizational point of view. Recommendations were made which might facilitate the implementation of future appraisal schemes throughout the organization.

Attitude of Health Personnel↗
PubMed1995

Ethical issues in qualitative nursing research.

This article is concerned with ethical issues that have to be considered when undertaking qualitative research. Some of the issues--such as informed consent, the dignity and privacy of the research subjects, voluntary participation and protection from harm--are the same as in other types of research and have their basis in moral and ethical principles. Qualitative research, however, generates specific ethical problems because of the close relationship that researchers form with participants. Qualitative research with patients is especially difficult because of their vulnerability and lack of power in the clinical situation. Therefore the potential conflict between the dual role of the nurse--the professional and the research roles--has to be solved. Researchers also learn how to cope with the tension of subjective and objective elements of the research. Nurses who attempt qualitative research have to consider a variety of complex ethical issues, which are addressed in this paper.

Behavioral Research↗
PubMed1994

'They know best': women's perceptions of midwifery care during labour and childbirth.

The aims of the study were to examine women's experiences of their labour and the birth of their baby. The use of qualitative method ensured that the research focused on the perspectives of the participants. The purposive sample consisted of 11 women volunteers in a maternity unit of a general hospital. Unstructured, tape-recorded interviews provided an opportunity for the informants to express their thoughts and feelings. The constant comparative method, a feature of Grounded Theory, was used to analyse the data. The research demonstrated that women trust midwives because the latter are seen as experts who 'know best'. In doing so, women place themselves in the hands of professionals giving them the authority to make decisions about procedures, drugs and types of care. This belief in the professionals' expertise influences the type of relationship between the women and midwives. Nevertheless, women also want to take an active part in the control of labour. The study identified a need for a flexible relationship between women in labour and their midwives.

Female↗
PubMed1990

The effect of anaesthesia on the bone blood flow of the rabbit.

The effect of anaesthesia on the rate of bone blood flow in the rabbit was studied. Two estimates of bone blood flow were performed, using 15 microns radioactively labelled microspheres, in three groups of rabbits. The first group was anaesthetised and the interval between the two estimates was 5 min. The second group was also anaesthetised but the interval between estimates was 60 min. The third group of rabbits was conscious and the interval between the two estimates was 4 h. In the first group, small uniform falls in whole bone blood flow were observed (mean change = -5%). In the second group, larger and less predictable reductions were observed (mean change = -24%). In the third group (conscious), little change was observed in whole bone blood flow during the 4-h experiment (mean change = +7%). It is concluded that substantial falls can occur in bone blood flow in the rabbit during a 1-h anaesthetic. If bone blood flow is to be monitored under anaesthesia, then the effect of the anaesthetic on bone blood flow must be accurately defined. In conscious rabbits, estimates of whole bone blood flow performed at an interval of 4 h under control conditions will give reproducible results.

Anesthesia↗
PubMed1979

Whole body elemental composition during drug treatment of rheumatoid arthritis: a preliminary study.

Thirty-two female patients with rheumatoid arthritis were divided into 3 groups and treated for 6 months with prednisolone, depot tetracosactrin, or indomethacin. Their whole body content of calcium, phosphorus, and nitrogen was measured before and after 3 and 6 months' treatment by in-vivo neutron activation analysis. No significant changes in these body elements were observed as a result of the treatments. The average amounts of calcium, phosphorus, and nitrogen were lower than normal in these patients, a finding consistent with the frequent observation of osteoporosis and muscle wasting in rheumatoid arthritis.

Adult↗
PubMed1978

Concurrent estimation of total body and exchangeable body sodium in hypertension.

1. Total-body neutron-activation analysis in vivo was carried out in 11 hypertensive subjects to measure simultaneously the total body content of sodium, chlorine, calcium, phosphorus and nitrogen. 2. There was a highly significant correlation between total body sodium measured by activation analysis and total exchangeable sodium measured by a standard isotope-dilution technique (r = 0.92, P less than 0.001). Exchangeable sodium averaged 80.3% of total body sodium. 3. The measured values of chlorine, calcium, phosphorus and nitrogen were similar to those for healthy subjects reported by others. 4. Activation analysis in vivo appears promising as an additional tool for investigating sodium metabolism in hypertension, as it is the only method available for determining the total body content of this element. The radiation dose (1 rem) is sufficiently low to permit repeated measurements in the same subject.

Adult↗
PubMed1978

Neutron uniformity studies related to clinical total body in vivo neutron activation analysis.

Methods of assessing the uniformity of thermal and fast neutron fluence in relation to total body in vivo neutron activation analysis are described. Results are presented for 14 MeV neutrons emitted by sealed tube generators housed in a massive concrete shield, representing a substantial source of neutrons degraded in energy. Optimisation of conditions for patient irradiations is discussed and it is shown that acceptable uniformity of fluence can be achieved with little or no premoderation of the incident neutrons.

Activation Analysis↗