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Biomedical subjects

K Oberle

Publications and source records attributed to K Oberle.

At least 19 recordsLinked to original sources
PubMed2001

Doctors' and nurses' perceptions of ethical problems in end-of-life decisions.

AIMS: To identify and compare doctors' and nurses' perceptions of ethical problems. Rationale. Ethical problems are a source of tension for health professionals. Misunderstandings or conflicts may result from differing perceptions of ethical problems. If true collaboration is to be achieved, it is important to understand the perspectives of others, particularly when difficult end-of-life decisions must be made. METHODS: In this qualitative study a total of seven doctors and 14 nurses working in acute care adult medical-surgical areas, including intensive care, were asked to describe ethical problems that they frequently encounter in practice. Interviews were taped and transcribed. Thematic analysis followed. RESULTS: All participants experienced ethical problems around decision making at the end of life. The core problem for both doctors and nurses was witnessing suffering, which engendered a moral obligation to reduce that suffering. Uncertainty about the best course of action for the patient and family was a source of moral distress. Competing values, hierarchical processes, scarce resources, and communication emerged as common themes. The key difference between the groups was that doctors are responsible for making decisions and nurses must live with these decisions. Each group, therefore, asked different questions when encountering and interpreting sources of moral distress. CONCLUSIONS: It was concluded that observed differences between doctors and nurses were a function of the professional role played by each rather than differences in ethical reasoning or moral motivation. Although this was a small qualitative study on one institution, and may not be generalizable, results suggest that doctors and nurses need to engage in moral discourse to understand and support the ethical burden carried by the other. Administrators should provide opportunities for discourse to help staff reduce moral distress and generate creative strategies for dealing with this.

Adult↗
PubMed2000

Hemin-dependent growth and hemin binding of Bartonella henselae.

Bartonella henselae causes cat-scratch disease and bacillary angiomatosis peliosis. The bacteria reside in erythrocytes of asymptomatic cats, which represent the natural reservoir for this pathogen. B. henselae is usually grown on blood-enriched media. Growth experiments on Brucella medium without blood demonstrated that heme compounds are essential for the growth of B. henselae and can completely substitute the addition of blood components. The heme precursor protoporphyrin IX alone, or in combination with FeCl(2) or FeCl(3), as well as transferrin or lactoferrin did not support growth, indicating that B. henselae cannot synthesize heme itself. Hemin supported growth even when free iron was chelated, indicating that hemin is also used as an iron source. Binding assays showed that hemin starvation increased the binding capacity of B. henselae for hemin, providing evidence that the bacteria carry a specific hemin uptake system, which might be regulated by hemin.

Bartonella henselae↗
PubMed2000

Development of an instrument to investigate parents' perceptions of research with newborn babies.

Neonatal intensive care nurses are often involved in research protocols as investigators, research assistants or staff nurses implementing the protocol and providing support and explanations to families. It is important, therefore, that nurses have information about parents' understanding of and attitudes towards the research process. The purpose of this study was to begin an exploration of parents' perceptions about research with newborn babies through the development and validation of a survey instrument. The questionnaire included: demographic questions; scaled items about research with newborn babies; scenarios describing research studies that varied in degree of risk and benefit to the newborn baby; questions about parents' willingness to enrol their newborn baby in the studies described; and questions regarding circumstances under which consent should be sought. Content and face validity were established by an expert panel and a pilot test conducted with a small group of health care professionals and lay persons. A convenience sample of 231 parents of newborn babies completed the final version of the questionnaire. Factor analysis revealed seven factors corresponding to issues identified in the literature, providing evidence of construct validity. Parents appeared to have no difficulty in completing the instrument and all questions were answered by the majority of participants. It was concluded that the questionnaire had adequate psychometric properties and that a mixed method approach can be fruitful in exploring sensitive issues.

Adult↗
PubMed2000

Ethical issues in public health nursing.

This qualitative study was designed to explore ethical issues in public health nursing in the Canadian context, and to begin to identify strategies to support ethical practice. Twenty-two public health nurses, 11 in rural and 11 in urban settings, were asked to describe ethical problems they had experienced in the course of their work. These participants most often described situations that required a relational response rather than an active choice between options. Their goal was to optimize the good, while at the same time maintaining a supportive relationship. Analysis revealed five interrelated themes, each with several subthemes: relationships with health care professionals; systems issues; character of relationships; respect for persons; and putting self at risk. It was clear that all aspects of public health nursing have ethical components.

Ethics, Nursing↗
PubMed1998

Seroprevalence of antibodies to Bartonella henselae in patients with cat scratch disease and in healthy controls: evaluation and comparison of two commercial serological tests.

Serologic testing for the presence of antibodies to Bartonella henselae is a widely accepted diagnostic procedure for laboratory confirmation of the diagnosis of cat scratch disease (CSD). In this study a commercially available indirect immunofluorescence assay (IFA) based on B. henselae-infected human larynx carcinoma cells (test A) was evaluated. Sera from 42 patients with CSD (20 confirmed by PCR) and 270 sera from healthy controls (consisting of 63 cat owners, 65 individuals whose last close contact with cats was >6 months previously, and 142 persons who had never been exposed to cats) were investigated for antibodies to B. henselae. All patients with CSD had titers of immunoglobulin G (IgG) to B. henselae of 128 or higher (test A; sensitivity, 100%). Of the 270 controls 189 (70%) were seronegative (titer, <64), 38 (14.1%) had titers of 64, 30 (11.1%) had titers of 128, 9 (3.3%) had titers of 256, and 4 (1.5%) had high titers, 512 (test A; specificity, 70%). Of the cat owners and individuals who had never had close contact with cats, 71.4 and 71.12%, respectively, were seronegative, and titers of 64, 128, 256, and 512 were found in 14.3 and 16.2%, 1.6 and 10.5%, 9.5 and 0.7%, and 3.2 and 1.4%, respectively. The sera from the patients and from the first 100 healthy adults without a history of close contact with cats were additionally tested with a second commercially available IFA, based on Vero cells infected with B. henselae and Bartonella quintana (test B). The sensitivity and specificity of test B were 93 and 73%, respectively. For patients with CSD the cross-reactivity between B. henselae and B. quintana in this test was 95%. Both systems are highly sensitive but less specific for detection of IgG antibodies to B. henselae in samples from patients with clinically apparent CSD. For detection of IgM antibodies, test A seems to be more sensitive (88%) and more specific (95%) than test B (sensitivity and specificity of 64 and 86%, respectively). The data show that the seroprevalence of antibodies to B. henselae in German individuals is high (30%). Low antibody levels are not sufficient evidence of active or prior infection.

Adolescent↗
PubMed1996

Are outbreaks and sporadic respiratory infections by Mycoplasma pneumoniae due to two distinct subtypes?

Thirty-seven clinical isolates of Mycoplasma pneumoniae, cultured from patients' respiratory material between 1986 and 1994, were typed by immunological methods and by polymerase chain reaction (PCR). For immunological typing two monoclonal antibodies (mAb) were used that recognized the P1 adhesion of Mycoplasma pneumoniae strain FH but differed in their ability to inhibit the adherence of Mycoplasma pneumoniae to erythrocytes. The mAb P1.58, which was not able to inhibit adherence, showed reactions with all patients' isolates in immunoblots, whereas the adherence-inhibiting mAb P1.62 reacted with only seven patients' isolates. Due to variations within the P1-adhesin genome of Mycoplasma pneumoniae group 1 (Mycoplasma pneumoniae type strain M129) and group 2 (Mycoplasma pneumoniae type strain FH), two primer sets were designed. According to the size of the PCR-amplification products, all clinical isolates that showed no mAb P1.62 reactivity belonged to Mycoplasma pneumoniae group 1, whereas mAb P1.62-positive-reacting mycoplasma isolates were characterized as group 2 strains. During an outbreak of Mycoplasma pneumoniae diseases in 1992, all 19 clinical isolates showed no cross-reactivity in immunoblots with the mAb P1.62 and were typed by PCR as Mycoplasma pneumoniae group 1 strains. Furthermore, 206 Mycoplasma pneumoniae complement fixation test-positive patient sera (titer > 1:40) from the study period were tested for adherence-inhibiting antibodies towards both type strains. Thirty-two sera showed adherence-inhibiting antibodies towards group 1 and 22 towards group 2 mycoplasmas. In only seven sera were adherence-inhibiting antibodies directed to both Mycoplasma pneumoniae groups. The serological data of the outbreak in 1992 revealed that patients with Mycoplasma pneumoniae group 1 infections developed adherence-inhibiting antibodies more frequently than did patients infected with group 2, which might have implications for the pathogenesis of Mycoplasma pneumoniae diseases and subsequent infections.

Adolescent↗
PubMed1996

Cardiovascular risk screening for women.

Cardiovascular disease is the leading cause of death of both men and women in Canada and the United States. The medical and societal emphasis on the occurrence of cardiovascular disease in men has resulted in an inclination to minimize its existence and severity in women. The purpose of this article is to assist clinical nurse specialists in cardiovascular risk-screening of women by providing a review of cardiovascular risk factors specific to women. Current knowledge about lipids, hypertension, diabetes, smoking, menopause, obesity, sedentary lifestyle, stress, and multiple roles are discussed. The clinical presentation for women and the clinical implications are presented. Lastly, implications for future research are described.

Cardiovascular Diseases↗
PubMed1995

Molecular mimicry by Mycoplasma pneumoniae to evade the induction of adherence inhibiting antibodies.

Specific regions of adherence binding sites and epitopes of the P1 adhesin of Mycoplasma pneumoniae were synthesised as octapeptides and used as targets in a modified enzyme-linked immunosorbent assay. Acute phase and convalescent sera from 10 patients with M. pneumoniae infection were tested for antibody reactivity to these octapeptides. In convalescent sera, antibody activities were directed against octapeptides of the epitope regions, whereas no antibody activity was found in acute or convalescent sera to octapeptides of adherence-mediating binding sites could be explained partially from the results of cross-reactivity experiments with adherence-inhibiting anti-P1 adhesin monoclonal antibodies (MAbs). Two of these MAbs showed cross-reactions with intracellular antigens of eukaryotic cell lines in immunofluorescence microscopy experiments. The cross-reacting antigens were isolated and characterised as glyceraldehyde-3-phosphate dehydrogenase and 2-phospho-D-glycerate hydrolyase. Antigenic mimicry of eukaryotic structures by functional sites of the P1 adhesin of M. pneumoniae may influence the pathogenesis of M. pneumoniae infection.

Adhesins, Bacterial↗
PubMed1995

Measuring nurses' moral reasoning.

The purpose of this exploratory study was to examine the possibility of designing a satisfactory method, using written responses to hypothetical scenarios, for evaluating the quality of moral reasoning in student nurses. Scenarios were developed from interviews with practising nurses. Nurses and student nurses provided written responses to the scenarios, and nursing faculty members from six institutions sorted the responses according to their perceptions of quality (i.e. 'best', 'next best', 'worst' etc.). There was very little agreement among faculty members on the quality of the responses. Consequently, it was impossible to develop a 'best' response on which the faculty members could agree. Analysis revealed a framework used by the participants for ethical decision-making. The results of this study have important implications for the way in which we think about the teaching and the evaluation of nursing ethics.

Beneficence↗
PubMed1994

Breast augmentation surgery: a women's health issue.

Surgery to increase breast size is a common procedure. In this paper we examine the reasons why women choose to undergo the procedure, the history of breast enhancement, current surgical approaches, possible complications and their treatment. Driving forces behind the choice to have augmentation surgery appear to be related to feelings of low self-esteem and self-confidence. Although there is a large literature related to breast augmentation, little of it is research-based. The research that there is focuses on complications and their treatment, with an emphasis on capsular contracture. Few of the studies are long-term, although complications have been noted as long as 25 years after initial implantation. There is a need for research into the experience of women undergoing augmentation mammaplasty but, perhaps more importantly, there is also a need to examine ways in which women can be helped to accept themselves as they are.

Breast Implants↗
PubMed1993

Submucous resection: is it a simple procedure?

With the need to cut costs in the health care system, there has been a rapid increase in the number of surgical procedures performed on an outpatient basis. It is therefore important that patients have enough information to enable them to cope at home. To determine the informational needs of patients undergoing several surgical procedures and examine their postoperative course, a telephone survey was conducted. The results from one group, those undergoing a submucous resection (SMR), stood out. When compared with the 292 patients in the overall study, the 33 SMR patients complained of considerably more discomfort, tiredness, and nausea. Sixty percent of these patients were not satisfied with the information they received. Most would have liked more information about how they would feel postoperatively and how they could cope with their various concerns and problems. The teaching materials and approach to postoperative care for these patients may need to be altered.

Adult↗
PubMed1993

An exploration of nursing disillusionment.

A model of supportive care developed in prior research, combined with ethical theory, is used as a framework for analyzing some of the current problems facing the nursing profession. The authors argue that a central cause of nursing disillusion is dissonance between personal values rooted in an ethic of caring and a health care system that rewards technological competence above human values.

Burnout, Professional↗
PubMed1993

Incomplete neural deficits in thoracolumbar and lumbar spine fractures. Reliability of Frankel and Sunnybrook scales.

Because neural status is used both as a treatment determiner and outcome measure, a universal, reliable scale is required. Experienced personnel, provided with concise definitions, demonstrated high inter-rater reliability of Frankel and Sunnybrook scales (Pearson correlation coefficients 0.71-0.91), with 94-100% intra-rater agreement. Both scales correspond to total sensory and motor function but are insensitive to walking and bladder function. Frankel's wide clinical use, reliability, and simplicity identify it to be the preferred measurement system until a better alternative is developed. Discussion of neural status must include description of bladder and walking function.

Adolescent↗
PubMed1991

A decade of research in locus of control: what have we learned?

Locus of control has received considerable attention from nurse researchers over the past decade. A review of nursing studies related to locus of control reveals that the collective results of this research have yielded little information that is useful for nursing practice. It is noted that many of the criticisms levelled at locus of control research at the beginning of the decade are still problematic. For example; most studies are correlational in design; instruments used to measure the construct suffer from reliability and validity problems; researchers have failed in many cases to consider the multidimensional nature of the construct; and in most studies the value of the reinforcer is ignored. If future research in this area is to lead to useful results, nurse researchers must be prepared to move to experimental designs, and must pay greater attention to issues of reliability and validity.

Acute Disease↗