My brilliant career-human resources. Life at a gallop. Interview by Nick Edwards.
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Administrative Personnel↗
Biomedical subjects
Judith Smith
Publications and source records attributed to Judith Smith.
PCT merger. Building bridges.
Primary care trusts can be torn between the need for critical mass and the danger of losing local vision and ownership; mergers are politically unpopular and fraught with difficulty. A review of Trafford South PCT stakeholders enabled a range of organisational models to be tested. The result was the creation of a 'joint and integrated management structure' for the two Trafford PCTs.
Community Health Planning↗
Accuracy of weighing simulated infants with in-bed and freestanding scales while connected and disconnected to a ventilator.
PURPOSE: To develop an accurate method of weighing ventilated infants in the clinical setting. SUBJECTS: Two dolls that simulated ventilated infants were adapted to different weights ranging from 745 to 3,995 g. DESIGN: Four methods of weighing ventilated infants were evaluated. The study design used multiple clinical nurses, randomly chosen, to weigh the simulated infants. Freestanding and in-bed scales were used with a simulated ventilated infant being either connected or disconnected from the ventilator tubing for the procedure. RESULTS: The mean weights of the simulated infants measured in the incubator, with or without the ventilator connected, had a mean difference of +/- 2 g from the gold standard. However, the mean weights of the simulated infants measured on the freestanding scales were 12 g < the gold standard of industry calibrated weights (P < 0.001). The measurement error was small both with and without the ventilator connected. This error was proportionally very small for weights over 1,500 g, but was increased for weights < 1,500 g. CONCLUSION: The use of in-bed scales was the most accurate method of weighing simulated infants of all weight categories. This study shows the importance of a consistent and meticulous technique when weighing infants in intensive care. The accuracy of weights is enhanced with the use of in-bed scales, and this is particularly significant in infants less than 1,500 g.
Body Weight↗
PCT commissioning. About the size of it.
Primary care trust commissioning is not advanced and there is little evidence of PCTs influencing hospital services. Any further NHS reorganisation would hamper the development of commissioning. PCTs need to engage more GPs in the task of commissioning services. PCTs' ability to move work round on a cost per case basis should strengthen their hand in commissioning from hospitals.
Accreditation↗
Phase I study of weekly gemcitabine as a radiation sensitizer for unresectable pancreatic cancer.
PURPOSE: To determine the maximal tolerated dose and dose-limiting toxicities (DLTs) of weekly gemcitabine with concurrent radiotherapy (RT) in patients with unresectable adenocarcinoma of the pancreas. METHODS AND MATERIALS: Patients who had locally advanced or recurrent unresectable pancreatic cancer were eligible. Gemcitabine was administered as a 30-min infusion once weekly for a total of five cycles during the course of RT. The starting dose of gemcitabine was 350 mg/m(2)/wk. Doses were escalated by increments of 25% in successive cohorts of 3-6 patients. RT was delivered at 180 cGy/d to a total dose of 5400-5580 cGy to the gross tumor volume. RESULTS: Nineteen patients were entered in this study through three dose levels (350-550 mg/m(2)/wk). The maximal tolerated dose was determined to be 440 mg/m(2)/wk. The DLTs were neutropenia, thrombocytopenia, and failure to receive all five cycles of gemcitabine. Other non-DLTs included 16 Grade III toxicities, which consisted of thrombosis, infection, nausea, vomiting, hypotension, constipation, diarrhea, and fatigue. One patient at each gemcitabine dose level experienced Grade IV vomiting, and the patient at the 550 mg/m(2) dose developed Grade IV anorexia. CONCLUSION: The maximal tolerated dose of gemcitabine when administered as a 30-min infusion once weekly during RT for unresectable pancreatic cancer was found to be 440 mg/m(2)/wk. The DLTs were neutropenia, thrombocytopenia, and failure to receive all five cycles of chemotherapy. Concurrent gemcitabine and RT is reasonably well tolerated and deserves additional evaluation against the current standard of care.
Adult↗
The role of primary prophylactic factor replacement therapy in children with severe factor X deficiency.
Severe factor X (FX) deficiency is one of the severest inherited coagulation disorders. Clinical manifestations include umbilical cord, mucosal, joint and central nervous system bleeding. Four Irish children with severe FX deficiency presented with umbilical cord bleeding. One developed an intraperitoneal haemorrhage and another an intracranial bleed. Prophylaxis, using intermediate purity Factor IX concentrate, was commenced within the first month of life, necessitating the insertion of central venous access devices in two of the children. All children have normal joint function, suggesting that prophylaxis commenced early in life reduces the incidence of arthropathy and improves quality of life.
Adolescent↗
Discharge planning.
BACKGROUND: Two audits were conducted by a small team of nurses to measure the effectiveness of discharge management and planning in a four-ward orthopaedic and trauma unit. Co-ordinating this process is an important part of the nurse's role, as discharge planning is a vital component of effective bed management. This work focused on changing practice and measuring change, rather than on the effects of length of stay in hospital. CONCLUSION: The findings showed that some wards were proactive: planning started on admission and patients were given realistic planned discharge dates and a list of probable capabilities. However, discharge planning varied from ward to ward, and there was no shared common practice. Both audits reflect the need to raise the profile of discharge planning and audit, to increase staff co-operation with the planning process.
England↗