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Biomedical subjects

K Hurst

Publications and source records attributed to K Hurst.

At least 19 recordsLinked to original sources
PubMed2004

The MS Symptom and Impact Diary (MSSID): psychometric evaluation of a new instrument to measure the day to day impact of multiple sclerosis.

OBJECTIVES: This study aimed to develop further a diary originally devised to measure the impact of multiple sclerosis (MS) as part of a cost utility study of beta interferon, and to evaluate its reliability, validity, and responsiveness in an outpatient sample of people with MS. METHODS: The original diary was further developed using qualitative and quantitative methods to ensure that it addressed the views of people with MS. The psychometric properties of the MS Symptom and Impact Diary (MSSID) were evaluated in a sample of 77 people who completed the MSSID daily for 12 weeks. Internal and test-retest reliability, discriminant and convergent validity, and responsiveness were assessed using traditional psychometric methods. RESULTS: The MSSID formed three, internally consistent scales that measured mobility, fatigue, and the overall impact of MS. The test-retest reliability of the mobility scale was adequate for individual comparisons (ICC>0.90) and the fatigue and overall impact scales were adequate for group comparisons (ICC>0.70). The MSSID was able to distinguish between clinical groups depending on clinical course, indoor ambulation status, and relapse status. It demonstrated associations with other single point instruments in the expected direction. Compared with single point instruments, its responsiveness was similar or better, especially in detecting short term improvements in functioning. CONCLUSIONS: The MSSID may provide a useful complement to currently available instruments to measure the outcomes of MS within clinical trials. Further research is needed to explore its feasibility in the context of a randomised controlled trial and its utility for clinicians.

Activities of Daily Living↗
PubMed2000

Primary care organisation and management. Evidence from a total purchasing pilot.

This paper reports the experience of a single pilot in total primary care purchasing (TPP) between 1995 and 1997. The article's structure is based on a framework created from the seven original objectives of the pilot and 12 themes emerging from qualitative data analysis. Data are mainly drawn from interviews with participants. Interesting and useful findings emerge. For example, the TPP was able to build positive relationships with other local actors and amongst its GPs, though these did not necessarily lead to agreement or compliance. The TPP undertook conventional health needs assessment, but experienced difficulty reviewing referral practice and controlling the volume of secondary care services, contributing to problems of financial control. Though TPP has been abolished, the findings have implications for successors.

Comprehensive Health Care↗
PubMed1999

Nursing acute psychiatric patients: a quantitative and qualitative study.

Political and managerial attention has focused on the consequences of the failure of community services to provide effective care to a small number of people with severe mental illness. However, the nature and value of care in hospitals have received less scrutiny. This paper addresses deficiencies in our knowledge about nursing care in acute psychiatric wards. It reports the findings from a recently completed study for the United Kingdom Department of Health. Four key developments are identified which, together, pose significant problems for nursing in acute wards: the increasingly diverse patient mix in wards; the volume of administrative duties performed by nurses; the weakness of multidisciplinary team working; and inappropriate education. In conclusion, the challenges for managers and clinicians responsible for local policy and practice and, by extension, those at the centre responsible for such services, are examined.

Acute Disease↗
PubMed1999

Individuals with low back pain: how do they view physical activity?

BACKGROUND: Recent guidelines for those with acute low back pain have advocated early resumption of normal activity and increased physical activity. Little is known about the relationship between low back pain and physical activity, and on the impact of that relationship on the promotion of increased levels of physical activity within a general practice population. OBJECTIVES: We aimed to explore associations between factors that influence changes in physical activity and the way individuals perceive and behave with their low back pain, and the impact of those perceptions and behaviour on physical activity. METHODS: Twenty-seven informants were chosen using a purposive sample from a larger group of individuals who, because of their low back trouble, had been referred by their GPs to a community-based, single-blind, randomized controlled trial (RCT) at the University of York, which is evaluating the effectiveness and cost-effectiveness of a progressive exercise programme. Fifty-four interviews were conducted with this subgroup of the RCT; four informants were interviewed once, 19 twice and four of them three times. Interviews were transcribed and analysed using manual and computer-aided approaches. RESULTS: Physical activity was perceived as (i) activities of daily living, (ii) activities causing breathlessness that they went out of the way to do and (iii) more competitive-type activity. The avoidance of physical activity and fear of pain returning were the two main factors directly associated with informants' backs and changes in physical activity. These two factors hindered increases in physical activity, even though the majority of informants believed strongly that being physically active helped ease their low back pain. CONCLUSIONS: When advocating that individuals with acute low back pain return to or increase physical activity, it is important that clinicians identify avoidance of physical activity and/or fear of pain at the earliest stage in order to tailor advice and reassurance appropriately. If avoidance of activity and fear of pain is identified and clinicians want to encourage patients to take up and sustain increased physical activity, they should explore issues of fear of pain, and avoidance of and confidence to do physical activities, in addition to other factors influencing physical activity.

Adult↗
PubMed1999

Clinical governance in accident and emergency services.

Owing to NHS managers' preponderance with financial issues, the present Government made improving the quality of health services a statutory requirement in 1997. In this article, one means of improving the quality of health services, clinical governance, is examined in detail before some issues related to its implementation are described. The Trust's A&E services, the context for interpreting and applying clinical governance, are briefly described before introducing a force-field analysis that demonstrates the different elements when changing services broadly and clinical governance specifically. The final section concentrates on implementing and improving clinical governance in A&E departments.

Attitude of Health Personnel↗
PubMed1997

The nature and value of small and community hospital accreditation.

Discusses the characteristics of health care accreditation schemes, especially the implications of their voluntary status. Singles out the Trent small hospital accreditation scheme (TSHAS) for detailed and systematic evaluation. Describes the quantitative and qualitative evaluation methods, which involved a meta-analysis of the literature, interviews with key staff and questionnaires completed by other participants in TSHAS. The main findings, divided into ten themes, confirm much of the published work on accreditation. The findings also provide new insights into the nature and value of health care accreditation, notably about the direction in which accreditation needs to go if both community and larger hospital accreditation is to survive.

Accreditation↗
PubMed1997

Multi-skilled health carers: nature, purpose and implications.

Multi-skilling has been the most enduring element of patient-focused care in the UK. A recent report from the Manchester University Health Service Management Unit (HSMU) extended the multi-skilling debate and offered a framework for changing National Health Service workforce policy along multi-skilling lines. Examines the main HSMU issues in the light of broader empirical and other evidence. Assesses the strengths, weaknesses, opportunities and threats to multi-skilling. Concludes that multi-skilling protagonists still face a number of challenges.

Clinical Competence↗
PubMed1996

The changing roles of external examiners.

The nature and purpose of external examining and the role of external examiners are briefly discussed. Questions posed in Professor Silver's recent inquiry into undergraduate and postgraduate examinations is explained. Some answers and issues surrounding the questions raised in the inquiry are discussed at length. Notably, the perilous state of the current examiner system and the pitfalls facing educational centres are explored in detail.

Educational Measurement↗
PubMed1996

The managerial and clinical implications of patient-focused care.

Discusses five elements of patient-focused care (PFC). Clarifies issues surrounding the first element--aggregating patients--and debates the strengths and weaknesses of the second element--centralizing services in PFC units. Explores arguments for and against the third element--multiskilling and cross-training--including staff activity in conventional hospitals and PFC units, in depth. Discusses the structure of PFC teams and their management. Describes the main components of the fourth PFC element--integrated carepaths--and explores their role in clinical audit, computerization and seamless care. Examines the costs of PFC by comparing actual with expected costs. Makes managerial, clinical, educational and research implications throughout for staff working in or with PFC units.

Clinical Competence↗
PubMed1995

Promotions and relegations in the psychiatric nursing league.

This paper describes a complex set of patient and nursing data from 83 psychiatric wards. It explains how the data were collected and organized into a meaningful format using a quality league-table. The patient and nursing characteristics of high quality psychiatric wards ranking above the 74th percentile and the characteristics of low quality wards falling below the 26th percentile are compared and examined in detail. Startling similarities and differences in patient activity, nursing activity, and nursing quality in high and low quality wards are highlighted. Finally, some implications of the findings for nursing practice, management, and education are considered.

Hospital Units↗
PubMed1992

Expression and different polarity of aminopeptidase N in normal human colonic mucosa and colonic tumors.

Expression and cellular localization of brush-border enzymes (aminopeptidase N, dipeptidylpeptidase IV, lactase, maltase) in normal human colon, colonic polyps and malignant intestinal tumors were investigated with a panel of monoclonal antibodies reacting with either native or denatured proteins. The enzymes were detected on cryostat sections by indirect immunofluorescence staining, or affinity-purified and analyzed by gel electrophoresis and immunoblotting. Dipeptidylpeptidase IV, lactase and maltase were absent from all samples examined, while aminopeptidase N (APN) was detected at the basal membrane of the epithelial cells in most specimens of colon obtained from individuals free of intestinal tumors. In contrast, APN was frequently localized at the luminal membrane of the surface epithelium in large-intestinal mucosa distal to tumors, adenomas and hyperplastic polyps, and from members of hereditary colon cancer syndrome families. APN was also expressed in colonic tumors, where it was present in an apical cell membrane location in 3/23 adenomas and 14/35 adenocarcinomas examined. No correlation was found between tumor-cell invasiveness (classified by "Dukes" stage) and expression or cellular location of aminopeptidase N. Histologically, all positive tumors were moderately or well differentiated. These results suggest that aminopeptidase N is normally expressed in adult human colon, but epithelial cells in the large and small intestine differ in their ways of sorting this enzyme intracellularly and eventually inserting it into different aspects of their surface membrane, a process which may be altered at an early stage of carcinogenesis.

Aminopeptidases↗
PubMed1992

Make or break.

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Nursing Administration Research↗
PubMed1992

Specifying quality in health and social care.

Two popular ways of specifying the quality of health and social care are explained. Examples are used to illustrate: (a) the mission statement/minimum standard method; and (b) the aim/objective method. Strengths and weaknesses of these approaches are highlighted by using a writing-style analyser, and an evaluation model from the literature. Ways of correcting some of the weaknesses are suggested.

Health Services↗
PubMed1991

The recognition and non-recognition of problem-solving stages in nursing practice.

A requirement for high-quality individualized nursing care is that nurses must recognize and attempt to solve patients' health problems. In this study, it was decided to investigate problem solving using a model similar to the nursing process derived from the general literature. Insight into nurses' perceptions and understanding of problem solving was gained by interviewing 116 nurses using vignettes of clinical problem solving. Data analysis revealed that many informants failed to discuss some problem-solving stages, in particular planning and evaluation. Conversely, problem assessment and implementation attracted more comment. The implications for these variations in nurses' problem-solving behaviour are examined in relation to contemporary nursing issues.

Humans↗
PubMed1990

Mind that child.

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Adolescent↗
PubMed1990

Sign for the times.

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Management Information Systems↗