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Biomedical subjects

J Fielding

Publications and source records attributed to J Fielding.

At least 19 recordsLinked to original sources
PubMed1997

Interpreting kappa values for two-observer nursing diagnosis data.

Reliability of nursing observations often is estimated using Cohen's kappa, a chance-adjusted measure of agreement between observer RNs. However, use of kappa as an omnibus measure sometimes can be misleading. In a study partly designed to describe the frequency and reliability of nursing diagnoses in long-term care facilities, 360 residents each were assessed independently by two registered nurses, and kappa and observed proportion of agreement were calculated as estimates of reliability. For some diagnoses we observed high proportions of agreement, yet paradoxically low kappa values. This article presents an in-depth statistical analysis to resolve this paradox. Results from our analysis also suggest means for planning improvements in the diagnostic performance of participating RNs. Consequently, our approach can be used in similar studies of diagnosis reliability to enhance nursing research, education, and practice.

Bias↗
PubMed1997

The reliability of saliva as a sample for the detection of hepatitis A immunoglobulins under various sampling conditions.

BACKGROUND: Saliva is increasingly being investigated as an alternative to serum for diagnostic and epidemiological testing even though antibody levels are substantially lower in buccal cavity fluids. However, there has been little study on whether buccal cavity activity and/or the timing of saliva sampling affects the diagnostic outcome, particularly in seropositive subjects. The absence of influence by these factors may be critical to the use of saliva for pre-vaccination screening for example. OBJECTIVES: The effects of eating, brushing of teeth and circadian rhythm on the measureable salivary immune status of 42 healthy individuals known to be serum and saliva anti-HAV positive were examined. STUDY DESIGN: A total of 141 saliva samples obtained from the 42 healthy subjects, before and after meals, before and after brushing of teeth and at various timepoints throughout the day, were assayed for total anti-HAV using an in-house saliva based enzyme-immunoassay, previously shown to have a 100% correlation in terms of sensitivity and specificity with a serum based assay. RESULTS: The results indicated that total anti-HAV titres varied according to the time of day and that eating had no significant effect on the total anti-HAV titre, but brushing of teeth did. Titres never varied to the extent that a result was falsely negative at any timepoint. CONCLUSION: These results confirm the usefulness of saliva as a diagnostic sample for the detection of hepatitis A antibody, regardless of sampling times, eating or tooth-brushing.

Antibodies, Viral↗
PubMed1997

Generic nursing outcome objectives for use in long-term care facilities.

Twenty-two registered nurses employed in four long-term care facilities generated data for a study about nursing diagnoses in long-term care (N = 360). Generic outcome objectives were developed as an integral part of the project. The research team also specified exceptions to the outcomes: instances where meeting outcome objectives might not be possible. The outcome objectives and exceptions for the sample's 20 most frequently occurring nursing diagnoses are presented as working statements. The authors expect that these outcome objectives and exceptions will be revised by nurses who use them in practice, basic and continuing education, and research.

Humans↗
PubMed1996

Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group.

BACKGROUND: In Japan the surgical approach to treatment of potentially curable gastric cancer, including extended lymphadenectomy, seems in retrospective surveys to give better results than the less radical procedures favoured in Western countries. There has, however, been no evidence from randomised trials that extended lymphadenectomy (D2 gastric resection) confers a survival advantage. This question was addressed in a trial involving thirty-two surgeons in Europe. METHODS: In a prospective randomised controlled trial, D1 resection (level 1 lymphadenectomy) was compared with D2 resection (levels 1 and 2 lymphadenectomy). Central randomisation (200 patients in each arm) followed a staging laparotomy. FINDINGS: The D2 group had greater postoperative hospital mortality (13% vs 6.5%; p=0.04 [95% Cl 9-18% for D2, 4-11% for D1] and higher overall postoperative morbidity (46% vs 28%; p<0.001); their postoperative stay was also longer. The excess postoperative morbidity and mortality in the D2 group was accounted for by distal pancreaticosplenectomy and splenectomy. In the whole group (400 patients), survival beyond three years was 30% in patients whose gastrectomy included en-bloc pancreatico-splenic resection versus 50% in the remainder. INTERPRETATION: D2 gastric resections are followed by higher morbidity and mortality than D1 resections. These disadvantages are consequent upon additional pancreatectomies and distal splenectomies, and in long-term follow-up the higher mortality when the pancreas and spleen are resected may prove to nullify any survival benefit from D2 procedures.

Adenocarcinoma↗
PubMed1996

Primary hepatic leiomyosarcoma.

Hepatomegaly was noted in a 63-year-old man who presented with an exacerbation of chronic pulmonary disease. A diagnosis of hepatic leiomyosarcoma was made by fine needle aspiration biopsy. Intensive investigations failed to reveal a primary source. The patient was treated conservatively.

Biopsy, Needle↗
PubMed1996

Health and unemployment.

This paper reviews the relationship between health and inadequate employment, especially unemployment. Poor physical or mental health can lead, via poor work performance, to job loss; however, studies that control for such selection effects are still scarce except for a few health outcomes. For example, aggregate-level studies typically find a positive association between unemployment and suicide rates over time. At the individual level of analysis, panel surveys of laid-off workers tend to find increased psychiatric problems such as depression and substance abuse. Few studies have evaluated interventions to prevent or reduce the adverse health effects of job loss. There have been even fewer studies of the health effects of other types of inadequate employment such as the increasingly prevalent forms of underemployment.

Adaptation, Psychological↗
PubMed1994

A comparison of hospital- and community-based mental health nurses: perceptions of their work environment and psychological health.

This study compares hospital- (n = 67) and community-based (n = 55) mental health nurses in relation to their perceptions of the work environment and also their psychological health. Measures include: the General Health Questionnaire, the Maslach Burnout Inventory and the Work Environment Scale. The data, obtained from self-returned questionnaires, show that community nurses rated their work environments higher for the dimensions of Involvement, Supervisor Support, Autonomy, Innovation and Work Pressure. Hospital nurses saw their environments as being higher in (managerial) Control. There were no differences between the groups for the dimensions of Peer Cohesion, Task Orientation, Clarity or (physical) Comfort. Furthermore, there were no overall differences between the two groups in relation to psychological health, although the pattern of factors associated with emotional well-being differed. Finally, analyses of the community data revealed that those nurses with 'flexitime' arrangements evaluated their work environments less positively and showed higher levels of psychological strain than did those working 'fixed-time' schedules. The findings suggest that the hospital and community environments make different demands on nursing staff, and that this should be considered when organizing nursing services if stress is to be avoided.

Adult↗
PubMed1994

Association of IBM's "A Plan for Life" health promotion program with changes in employees' health risk status.

To evaluate the association of participation in IBM's "A Plan for Life" program with changes in blood pressure, serum total, high-density lipoprotein, and non-high-density lipoprotein cholesterol, body mass index, and cigarette smoking, we compared changes in these measures over a 1- to 5-year period among program participants and nonparticipants initially found to be at risk. After adjustment for age, sex, time to follow-up, and baseline values, the proportion of participants no longer at high risk was significantly greater than the corresponding proportion of nonparticipants in the areas of blood pressure total and non-high-density lipoprotein cholesterol and smoking cessation.

Adolescent↗
PubMed1993

Contact with AIDS patients as a source of work-related distress: effects of organizational and social support.

In this study, we hypothesized that a nurse's exposure to acquired immunodeficiency syndrome (AIDS) patients as part of the work role is positively associated with distress as indexed by negative mood at work. Given this expected relation, we sought to identify factors that might reduce the negative effects of caring for AIDS patients on nurses. We predicted that both organizational and social support would moderate the relationship between extent of exposure and negative mood, with the relationship being strongest when support is low and weakest when support is high. The results of tests among a sample of 256 nurses supported all the hypotheses. We discuss implications of this study and directions for future research.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Haemoccult testing as an indicator of recurrent colorectal cancer: a 5-year prospective study.

A prospective study was conducted to assess the value of routine haemoccult testing as an indicator of early luminal recurrence of colorectal cancer. One hundred patients (mean age 72 years) undergoing radical resection (70% Dukes' B and 30% Dukes' C) for colorectal carcinoma were asked to provide 3-monthly haemoccult tests to a special follow-up clinic for a minimum of 5 years. Positive tests underwent further investigation with barium enema and colonoscopy. Patient compliance was 84%. Positive tests were obtained in 14 asymptomatic individuals, five of whom proved to have anastomotic recurrence. Recurrence was also identified in a further patient despite a negative haemoccult test. Three patients with anastomotic recurrence were able to undergo further radical surgery; two were still alive over 5 years after detection of recurrent disease. Haemoccult screening appears to detect increased numbers of patients with luminal recurrence (7.2%) when compared to historical controls (2.1%). Larger studies will be needed to determine if this increased detection rate results in improved long-term survival.

Aged↗
PubMed1990

Worksite health promotion: its evolution and the Johnson & Johnson experience.

Worksite health promotion, a rapidly growing form of preventive health service, may include health risk appraisal with communication of findings to the individuals tested. It may also assist in achieving and maintaining physical and mental fitness, controlling alcohol use, avoiding or quitting tobacco and other drugs, and otherwise maintaining health protective habits, while providing opportunities to control high blood pressure, and reduce elevated blood cholesterol, obesity, and other health hazards. This article presents a synopsis of the evolution of that movement and reviews the experience of one industrial firm that has endeavored to document and evaluate its effort. Such a review may be helpful in consolidating the various findings to date and in indicating the complexity of assessing the health and economic consequences of such an endeavor in private companies.

Health Education↗
PubMed1990

Exploratory project for development of nursing outcome criteria in long term care.

This exploratory project in developing outcome criteria for long term care was conducted with the view that the individual professional nursing practitioner has a unique, valuable contribution to make to the overall nursing quality assurance effort. Twenty-seven nurses volunteered to design and conduct individual systematic nursing diagnosis/intervention/outcome measurement projects. They were employees of five long term care facilities in New York state. Their contribution to this project was an embodiment of their professional judgement and practice with 107 selected clients under their care. They were prepared for participation through instruction repeated in all five facilities. The North American Nursing Diagnosis Association's Taxonomy of Nursing Diagnoses was used in the instruction, by the practitioners in their practice and data collection, and in the data analysis. Data analysis also included use of Campbell's nursing intervention category scheme. This work demonstrated that professional nurses are able to specify appropriate outcome criteria and to measure these outcomes of their planned nursing interventions. Eighty-seven percent of the expected outcomes were achieved as anticipated or in the anticipated direction. Results provided many leads for future study of nursing diagnosis/intervention/outcome measurement among residents of long term care institutions.

Humans↗
PubMed1988

Failure of second-look laparotomy to influence survival in epithelial ovarian cancer.

The survival benefit of second-look laparotomy after completion of primary chemotherapy in patients with epithelial ovarian cancer has been assessed in a prospective randomised trial of 166 patients. Patients were randomised into three groups. All were initially treated with cisplatin (100 mg/m2 x 5) after primary laparotomy. Group A (n = 53) was scheduled to have a second-look laparotomy, followed by cyclical oral chlorambucil. Group B (n = 56) was scheduled to have a second-look laparotomy, followed by total abdominal and pelvic irradiation, and group C (n = 57) received oral chlorambucil as for group A but had no second-look operation. With a median follow up of 46 months (range 21-64), no differences in survival were noted between the three groups. The median survival for group A was 21 months (95% CI 11-31 months), for group B 15 months (11-19), and for group C 17 months (8-26). Thus second-look laparotomy after completion of first-line single-agent cisplatin chemotherapy did not confer any survival benefit on patients with epithelial ovarian cancer.

Actuarial Analysis↗
PubMed1985

Size of spleen rather than amount of platelet sequestration may determine long term responses to splenectomy in adult idiopathic thrombocytopenic purpura.

Fourteen adults with idiopathic thrombocytopenic purpura suffered a relapse after treatment with steroids, vinca alkaloids, or intravenous gammaglobulin. Splenic sequestration of platelets labelled with 111In-oxine was assessed, and the patients then underwent splenectomy. During follow up of four to 47 months (mean 20.7) none of the patients required further treatment, including three of 14 who showed partial relapses. Splenic sequestration patterns did not predict relapses, but an unexpected finding was that patients who relapsed had significantly smaller spleens. It is concluded that splenectomy is beneficial in most adult patients with idiopathic thrombocytopenic purpura and that radiological techniques to measure the size of the spleen may be useful in predicting which patients may relapse.

Adolescent↗