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Biomedical subjects

J Costello

Publications and source records attributed to J Costello.

At least 19 recordsLinked to original sources
PubMed2006

Audit of Mobile Intensive Care Ambulance Service.

The transfer of critically ill patients between hospitals carries significant risk. The Mobile Intensive Care Ambulance Service (MICAS) in Ireland was established in 1996 to provide a ground transfer service between hospitals for critically ill patients. The aim of this audit was to determine if a centralised retrieval system for interhospital transport of critically ill patients in Ireland by MICAS is safe and efficient. 484 critically ill patients transported by MICAS between April 1996 and December 2004 were studied retrospectively. There were no patient deaths during transfer. 47% of transfers were between hospitals in the greater Dublin area. 45% were from regional centres to Dublin. 93% of patients required airway intervention before transfer (intubation or tracheostomy) and 32% needed inotropic support during transfer. The MICAS data confirm the demand for interhospital transport of critically ill patients and suggest that transfer using a centralised retrieval system is safe.

Adolescent↗
PubMed2004

Vermont granite mortality study: an update with an emphasis on lung cancer.

This mortality study extends the period of observation of an article published in 1988 of 5414 workers in Vermont granite sheds and quarries to assess whether previously reported reductions in silicosis and tuberculosis mortality were maintained. The relationship between lung cancer and quartz exposure is also examined by comparing mortality in workers hired before and after 1940, when dust controls were introduced and exposures were reduced by 80% to 90%. Before 1940, general stone shed air contained 20 million particles/cubic foot (mppcf) (approximately equivalent to 0.2 mg/m of quartz), and pneumatic chisel workers were exposed on average to 60 mppcf (approximately equivalent to 0.6 mg/m of quartz). Other workers had variable exposures. After 1940, a period of decline occurred in dust levels and then stabilized in approximately 1955, when average dust levels were 5 to 6 mppcf (equivalent to 0.05-.06 mg/m of quartz). Dust exposures in the Vermont industry is considered to be free of confounding occupational substances such as arsenic, although cigarette smoking was common. By the end of 1996, 2539 workers, or 46.9% of the cohort, had died. There were no silicosis deaths in workers hired after 1940 who were exposed only in the Vermont granite industry, illustrating the effect of lowering quartz exposures. Tuberculosis caused 2 deaths in those hired after 1940 (standardized mortality ratio [SMR] = 0.52; not significant). Overall lung cancer mortality was elevated in shed workers who had been exposed both to high levels of quartz before 1940 and to the lower levels prevailing after 1940 (SMR = 1.32; P < 0.01). Quarry workers did not show an excess of lung cancer (SMR = 0.73; not significant). When shed workers with high and low exposure histories (before and after 1940) but with comparable latency and tenure were contrasted, lung cancer mortality was similar. Differing levels of quartz exposure, which resulted in large differences in the mortality experience from silicosis, did not result in differences in lung cancer mortality. The results do not support the hypothesis that granite dust exposure has a causal association with lung cancer.

Cause of Death↗
PubMed2001

Measuring the elastic properties of fine wire.

The elastic moduli of fine wires made from MP35N and 304SS used in implantable biomedical devices are assumed to be the same as those published in the literature. However, the cold working required to manufacture the wire significantly alters the elastic moduli of the material. We describe three experiments performed on fine wire made from MP35N and 304SS. The experimentally determined Young's and shear modulus of both wire types were significantly less than the moduli reported in the literature. Young's modulus differed by as much as 26%, and the shear modulus differed by as much as 14% from reported values.

Alloys↗
PubMed2001

Nursing older dying patients: findings from an ethnographic study of death and dying in elderly care wards.

UNLABELLED: Nursing older dying patients: findings from an ethnographic study of death and dying in elderly care wards Background and aim. The aim of the study was to explore the experiences of dying patients and nurses working in three elderly care wards focusing on the management of care for dying patients. The majority of patients who die in hospital are over the age of 65 and evidence suggests that three fifths are over the age of 75. Older patients pose tremendous problems and challenges to nurses and doctors regarding the provision of good terminal care, particularly in relation to developing effective communication. METHOD: An ethnographic research design was chosen. The research sample consisted of 74 patients, 29 nurses and 8 physicians. The principle data collection methods were participant observation and semi-structured interviews. All respondents were interviewed following a period of observation on each of the ward areas. The data obtained from participant observation were then used to structure the interview questions. The purpose of asking questions about meanings associated with observational material was to evaluate the extent to which convergence or divergence of the data was taking place. FINDINGS: The findings demonstrate that the care of older dying patients was defined by a lack of 'emotional engagement' with the patient and the institutionalized nondisclosure of information about death and dying. The study raises issues concerning the lack of effective communication about terminal diagnosis and the strategies used by nurses and doctors for disclosing information about death and dying. The findings suggest that although nurses provide individual care to dying patients, much of this was aimed at meeting patients' physical needs. Nurses reported psychosocial aspects including spiritual and emotional care to be important, although there was little evidence of them being orientated towards this in practice. CONCLUSION: The indicative conclusions from this study suggest that terminal care for some elderly patients remains hampered by a reluctance of nurses and doctors to be more open in their communication about death. It would appear that hospital culture and the mores, beliefs and ideologies that emanate from the biomedical model, significantly shape the experiences of older dying patients.

Aged↗
PubMed2001

Peer review of classroom teaching: an interim report.

This paper provides interim findings from the implementation of peer review of classroom teaching in a large UK University School of Nursing, Midwifery and Health Visiting. A total of 258 classroom teaching sessions, involving 129 teaching staff (n=129) were included over a period of 7 months. Teachers had two teaching sessions reviewed by a colleague. One reviewer was self-nominated and the Dean of School allocated the other. The paper is in two parts. Part one includes a short literature review followed by a descriptive account of how peer review was implemented. Part two focuses upon individual experiences from a small scale study with data obtained from 14 teachers (n=14) who took part in qualitative interviews based on their experiences of being both reviewer and reviewee. The larger study gathered data from several sources. This paper presents the initial findings from interview data with nurse teachers. Their perceptions form the basis of a discussion, which raises issues related to the experience of both implementing and being involved in, peer review of classroom teaching. Four themes emerged from the interview transcriptions; peer review was initially perceived as a threat; the experience of peer review was a positive one; teachers felt that being a reviewer was an interesting and worthwhile experience and perceived peer review positively when good relations existed between them and their reviewer.

Attitude↗
PubMed2001

Isolation of Cladonema Pax-B genes and studies of the DNA-binding properties of cnidarian Pax paired domains.

Pax genes encode nuclear transcription factors that are involved in developmental control. They contain a conserved DNA-binding domain, the paired domain. The DNA-binding specificity of paired domains is directly related to the gene regulation function of Pax proteins. Pax genes were previously divided into five groups on the basis of a phylogenetic analysis of paired domains. In this study, two highly similar cnidarian Pax-B genes from Cladonema californicum, a jellyfish with eyes, were found and sequenced. In an effort to understand the function of the cnidarian Pax genes isolated in this and a previous study, we characterized the consensus DNA sequences bound by the cnidarian paired domains using a PCR-based method and electrophoretic mobility shift assays. The consensus DNA sequences obtained are very similar to those bound by mammalian Pax proteins. Comparison of known consensus sequences indicates that they are all partially palindromic, but this characteristic is most prominent in cnidarians, which suggests that the DNA sequences bound by the ancestral paired domain could have been palindromic. Also, cnidarian paired domains, like those of Pax-2/5/8, possess a broader binding specificity than other paired domains, which implies that the common ancestor of Pax-2/5/8 and Pax-4/6 paired domains could also have had a similar broad DNA-binding specificity. Thus far, a definitive Pax-6 gene has not been found in several cnidarian species examined, which is consistent with a later origin of the Pax-6 gene and raises two possibilities: the Pax genes of cnidarians are multifunctional and control two or more developmental pathways, including eye development, or they use a Pax-independent pathway for eye development. Whether this pathway does exist and is unique to cnidarians or it whether it represents a true master control under which Pax-6 was later included remains to be determined.

Animals↗
PubMed2001

Palliative care in a Mediterranean culture: a review of services in the Republic of Cyprus.

This article reviews the provision of palliative care services in the Republic of Cyprus, highlighting healthcare resources in general and palliative care in particular. An interesting feature of palliative care in Cyprus is the extent to which community palliative care provision appears to be expanding and developing, with hospice care supplementing the work of home care nurses. The role of the home care nurse is discussed and the key role played in patient and family education highlighted. The article raises some interesting features of the relationship between bereavement and culture highlighting the influence that medicalization of health has on traditional ways of caring for patients with cancer and non-cancer conditions.

Bereavement↗
PubMed2001

Identity theft: when bad things happen to your patients' and employees' good name.

What should healthcare facility security directors and administrators do when patients or employees are the victims of identity theft? Taking the right steps to safeguard personal data won't insulate your facility from ever having to deal with this growing crime but, says the author, it will reduce the opportunity and desire for a criminal to steal the data.

Access to Information↗
PubMed2000

Grief and older people: the making or breaking of emotional bonds following partner loss in later life.

The aim of this ethnographic study was to explore retrospectively the grief experiences of 12 older people whose partners had recently died in hospital, following a period of terminal illness. The rationale was based upon developing an understanding of the grief experiences of newly bereaved older people. In doing so, it is important to consider that grief is not only shaped by culture and social context but also by the nature of the relationship between the mourner and the deceased. For most of this century, the dominant conceptualization relating to grief and the social experience of bereavement has been based on the psychoanalytical school of thought. This process is said to involve the mourner passing through a number of stages or phases and forms the basis of the 'grief work hypothesis'. Using in-depth ethnographic interviews, the mourner's reactions to and perceptions of the loss were explored. Tape-recorded interview data were analysed using the inductive process of both content analysis and discourse evaluation. The findings from this study shed light on an area of conjugal bereavement that has received little attention in the past and challenges traditional models of grief. The indications are that in the first year of bereavement, the bereaved retain and modify the emotional relationship with their deceased partners, through a range of symbolic behaviours. The discussion raises issues concerning the need to consider the extent to which contemporary conceptualizations of grief explain the reactions of older people whose grief experiences are shaped by their social situation. The study also highlights important issues concerning the need to understand the complexity of grief experiences and bereavement support for older people which has a number of implications for nurses in both hospital and community settings.

Adaptation, Psychological↗
PubMed2000

'Healthy viewing?': experiencing life and death through a voyeuristic gaze.

Recent times have witnessed a groundswell in the number of British television programmes that deal with the 'real life' experiences of people in various health care settings. Such programmes tend to focus upon the two interrelated strands of the experience of those who deliver professional care and those who are at the receiving end of it. The usual rationale given for such programmes is that they offer insights about the delivery of health care that are not readily accessible to members of the public. This article will look beneath the rationale and reasons offered by programme makers for the existence of such documentaries. It will explore insidious and questionable elements that go beyond revealing the 'lived experience' of professional carers and those for whom they care. Emerging from this is the challenging notion that such programmes deliver the opportunity to experience the vulnerability, suffering and even death of others through a voyeuristic gaze.

Attitude to Death↗
PubMed2000

Truth telling and the dying patient: a conspiracy of silence?

This article reports on the findings of an ethnographic study of the terminal care of older dying patients in hospital. The study focused on the information given to 22 patients diagnosed with a life-threatening illness. Using data from participant observation and ethnographic interviews, the research examined the strategies used to control information about terminal diagnosis. Several ethical implications were raised, such as truth telling and collusion. The article examines the implications of implementing ward disclosure norms based on closed awareness. It also considers the issues associated with developing a truth-telling culture.

Aged↗
PubMed2000

Impact of preoperative education on pain management outcomes after coronary artery bypass graft surgery: a pilot.

Patients have been found to receive inadequate analgesia despite moderate to severe pain after coronary artery bypass graft (CABG) surgery. The purpose of this pilot study was to evaluate a preadmission educational booklet for patients undergoing their first uncomplicated CABG. A randomized controlled trial (RCT) was undertaken at the largest cardiovascular centre in Canada. Repeated measures were used to compare data from 3 interviews: at baseline, day 3, and day 5. Patients were randomly assigned to one of 3 groups at the preadmission clinic 2 to 7 days before surgery: (1) generic hospital booklet and videotape (control), (2) control + pain booklet, or (3) control + pain booklet and interview; 45 subjects completed all 3 interviews. Measures were the McGill Pain Questionnaire-Short Form and the American Pain Society Patient Outcome Questionnaire. For all groups, analgesic administration was inadequate (19.89[13.37] mg morphine equivalents/24 hours) despite unrelieved pain (6.63[2.46], 0-10). However, patients receiving the interventions in addition to control care received 46% more analgesia than patients receiving control care alone and had fewer concerns about asking for help and taking analgesia. Changes were not required in the intervention booklet or measures.

Adult↗
PubMed1999

Prospects for improved therapy in chronic obstructive pulmonary disease by the use of levalbuterol.

Like asthma, chronic obstructive pulmonary disease (COPD) is a chronic disease, the most prominent symptom of which is airway obstruction. Airway inflammation may be pathogenomic in both diseases, but only in COPD does inflammation predominate as a determinant of symptoms to make obstruction largely refractory to treatment. Despite a more limited degree of reversibility than in asthma, beta(2 )-agonists are used extensively to reduce airway obstruction and to achieve symptomatic improvement, with racemic albuterol being widely favored. In asthma, bronchodilation and bronchoprotection largely account for symptomatic benefit. In COPD, the capacity of racemic albuterol to ameliorate these symptoms is more limited and suppression of edema and of infiltration and activation of leukocytes acquire greater significance. During regular use of racemic albuterol in asthma, bronchoprotection diminishes progressively as hyperresponsiveness becomes increasingly pronounced, a process that is associated with an infiltration and activation of eosinophils. These paradoxic effects of racemic albuterol may be attributed to pharmacologic actions of the distomer, (S)-albuterol. As would be expected, homochiral (R)-albuterol (levalbuterol) is more potent and effective in asthma and may have significant advantages if used in COPD. A substantial (4-8-fold) reduction in the dose of levalbuterol anticipates lesser side effects and diminished risk in patients with cardiovascular disease. Additionally, the increased potency and duration of bronchodilation observed in asthma may extend to COPD. Finally, removal of the proinflammatory actions of (S)-albuterol may eliminate the persisting obstruction and decrease elastance that are associated with enhanced inflammation and may allow levalbuterol to suppress edema and diminish leukocyte activation more effectively.

Adrenergic beta-Agonists↗
PubMed1999

Model organ description protocols for completion by transplant surgeons using organs procured from medical examiner cases.

A significant number of donor organs emanate from the medical examiner's or coroner's offices, because victims of head injuries from vehicular accidents, falls, assaults, gunshot injuries, and unattended cerebrovascular accidents fall under the jurisdiction of the medical examiner or coroner. Unfortunately, many organ procurement organizations may not fully understand the legal responsibilities of the medical examiner. Most of the medical examiner or coroner cases could be used without compromising the medical-legal responsibilities of the medical examiner or coroner if a reliable description of the respective organ could be made after surgical removal by either having a pathologist present or by having the surgeon prepare a description of the respective organ. The objective of this paper is to present a series of protocols that have been designed to describe the heart, lungs, liver, kidney, and spleen for use by organ transplant surgeons. These protocols have proven to be highly successful in making more organs available for transplantation.

Autopsy↗