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Biomedical subjects

L N Smith

Publications and source records attributed to L N Smith.

At least 19 recordsLinked to original sources
PubMed2004

Enhanced zinc consumption causes memory deficits and increased brain levels of zinc.

Zinc deficiency has been shown to impair cognitive functioning, but little work has been done on the effects of elevated zinc. This research examined the effect on memory of raising Sprague-Dawley rats on enhanced levels of zinc (10 ppm ZnCO3; 0.153 mM) in the drinking water for periods of 3 or 9 months, both pre- and postnatally. Controls were raised on lab water. Memory was tested in a series of Morris Water Maze (MWM) experiments, and zinc-treated rats were found to have impairments in both reference and working memory. They were significantly slower to find a stationary platform and showed greater thigmotaxicity, a measure of anxiety. On a working memory task, where the platform was moved each day, zinc-treated animals had longer latencies over both trials and days, swam further from the platform, and showed greater thigmotaxicity. On trials using an Atlantis platform, which remained in one place but was lowered on probe trials, the zinc-treated animals had significantly fewer platform crossings, spent less time in the target quadrant, and did not swim as close to the platform position. They had significantly greater latency on nonprobe trials. Microprobe synchrotron X-ray fluorescence (microSXRF) confirmed that brain zinc levels were increased by adding ZnCO3 to the drinking water. These data show that long-term dietary administration of zinc can lead to impairments in cognitive function.

Aging↗
PubMed2003

Experience of cardiac rehabilitation after coronary artery surgery: effects on health and risk factors.

OBJECTIVE: Cardiac rehabilitation (CR) programs are provided to support the recovery process following acute myocardial infarction and coronary artery bypass grafting (CABG). Attendance varies. We related attendance following CABG to severity of cardiac symptoms, general health status (Short Form-36) and prevalence of modifiable coronary artery disease (CAD) risk factors. METHODS: 209 patients due to undergo CABG were recruited and assessed preoperatively as well as at a mean of 16.4 months postoperatively. General health status was measured using the Short Form-36 questionnaire. Severity of cardiac symptoms was assessed on a visual analogue scale. Modifiable coronary artery disease risk factors (smoking, body mass index, hypertension and elevated cholesterol) and social deprivation index were noted. RESULTS: There were ten early and three late deaths. Thirteen patients withdrew consent for investigation, therefore 183 were fully studied. Of these 65.0% completed a CR programme and 24.6% did not attend any programme; 10.4% partially completed (less than 50% of time) and were excluded from analysis. Nonattenders were more likely to be smokers (P=0.002), diabetic (P=0.028) and were more from socially deprived geographical areas (P=0.013), but the proportion of patients with BMI>25, BP>140/90 or cholesterol >5.0 mmol l(-1) were the same. There were no differences in age, preoperative NYHA score, number of grafts, angina recurrence (46 vs. 38%, P=0.35) or breathlessness (62 vs. 69%, P=0.40) between attenders and nonattenders. The severity scores of angina (2.7 vs. 3.2, P=0.286) and breathlessness (3.5 vs. 3.6; P=0.79) were no different. However, four of the eight health domains measured showed significantly better values for attenders than nonattenders; namely: general health (60 vs. 46%, P=0.001), physical function (64 vs. 51% P=0.01), role limitation physical (48 vs. 29%; P=0.02) and social function 74 vs. 62%, P=0.04). CONCLUSIONS: This is the first report using SF 36 to evaluate benefits from attending CR. Higher general health scores (SF-36) were associated with attendance at CR although CAD risk factors and cardiac symptoms were not improved but this may be due to the long interval between assessments.

Chi-Square Distribution↗
PubMed2002

Nurse-led welfare benefits screening in a General Practice located in a deprived area.

OBJECTIVE: To evaluate a nurse-led attendance allowance screening service in General Practice. DESIGN: Intervention study. SETTING: One General Practice located in two sites in deprived areas in the East-End of Glasgow (Carstairs Deprivation Index-6 and 4). PARTICIPANTS: Participants aged >64 y who in the nurses clinical judgment appeared to be physically or mentally frail were opportunistically recruited over a 12-week period by community nurses (health visitors, district nurses and practice nurses). A Welfare Rights Officer (WRO) contacted all potential underclaimers by telephone and offered a home visit in order to assess for unclaimed benefits. MAIN OUTCOME MEASURE: Total unclaimed attendance allowance and linked benefits. RESULTS: Thirty-seven of the original 86 participants plus four relatives were found not to be claiming the benefit payments that they were entitled to. Referral to the Department of Social Security (DSS) revealed unclaimed benefits to a total of: pound sterling112 893.00of this pound sterling95 306.00 is on a recurrent annualized basis and pound sterling17 587.00 as lump sums. CONCLUSIONS: A community nurse-led attendance allowance screening service combined with a home visit by a WRO was an efficient and highly effective model for maximising the income of the frail elderly. This model could contribute to reducing the increasing number of pensioners living below the poverty line.

Aged↗
PubMed2001

Postoperative pain: a comparison of adolescent inpatient and day patient experiences.

This three-year study investigated the experience of postoperative pain and its management following elective surgery in an adolescent population aged 12-18 years (n=351) in 5 NHS trusts. In addition to the adolescents, one parent of each adolescent and a range of health professionals including surgeons, anaesthetists and registered nurses were interviewed concerning their views on acute pain in adolescent patients. The results presented in this paper are those related to the management of day and inpatient surgery in this adolescent population. Data were collected pre-operatively and postoperatively (days 1 and 3) using semi-structured interviews, telephone interviews, self-completion questionnaires and standardised tools to measure pain intensity (Adolescent Pediatric Pain Tool), psychological adjustment to adolescence (Offer Self-Image Questionnaire-Revised) and emotional state (Hospital Anxiety and Depression Scale). Day cases were discharged on the day of surgery while most inpatients were discharged on the first postoperative day.

Adolescent↗
PubMed2001

The influence of general health status and social support on symptomatic outcome following coronary artery bypass grafting.

OBJECTIVES: To assess health status, level of social support, and presence of coronary artery disease risk factors before and after coronary artery bypass grafting (CABG); to assess symptomatic relief approximately 12 months postoperatively; and to examine the association between preoperative health status and recurrence of symptoms. DESIGN: Observational study. SETTING: Preoperatively, in hospital outpatient department (1995-1996); postoperatively, at home (1996-97). SUBJECTS AND METHODS: Patients awaiting elective CABG were recruited one month before the expected date of operation. Preoperative assessment included severity of symptoms, coronary artery disease risk factors, short form 36 (SF-36) questionnaire, and social activities questionnaire. The presence and severity of angina and breathlessness were reported postoperatively (mean 16.4 months). Multiple regression analysis was used to identify factors associated with improved outcome following CABG. MAIN OUTCOME MEASURE: Patient reported presence and severity of angina and breathlessness. RESULTS: 183 patients were followed for a mean of 16. 4 months after CABG. Angina and breathlessness were completely relieved in 55% and 36% of patients, respectively. In patients with residual symptoms, the severity was significantly reduced (angina p < 0.001; breathlessness, p = 0.02). Patients with low SF-36 scores and low social network scores preoperatively were less likely to be relieved of symptoms (p < 0.001). Health status and social support levels preoperatively were lower than in other reported coronary artery disease patients groups. Preoperatively, coronary artery disease risk factors were higher than recommended in current guidelines: 67.4% had raised plasma cholesterol, 39.0% were hypertensive, 80% were moderately obese, and 22.9% were smokers. CONCLUSIONS: Recurrence of symptoms exceeded other published studies. Patients' perception of general health, symptoms, and social support influences outcome.

Adult↗
PubMed2001

Stroke: an exploration of the experience of informal caregiving.

OBJECTIVE: To explore the experience of caregiving in informal carers of stroke patients. DESIGN: The research approach was qualitative. Data were collected one year after the stroke occurred using a semi-structured interview. The audio-taped interviews were transcribed and following this process were analysed thematically using constant comparative procedures. SETTING: West of Scotland. SUBJECTS: Twenty-two informal carers of stroke patients. RESULTS: The results are presented under the headings: Preparation for discharge/feelings about discharge; The early weeks/months at home; A year of caring; and The future. The main themes identified within these broad areas were as follows: physical preparation; emotional support; the supply of information and advice; and the provision of appropriate services (both social and health service provision). CONCLUSIONS: The data gathered in this small-scale study suggest that the physical and emotional toll associated with caregiving was great. Unfortunately, the help and support provided by the health and social services was often inadequate, inappropriate and poorly tailored to their individual needs. There was little evidence of a seamless flow of care between the secondary and primary care settings.

Adult↗
PubMed2000

Assessment of changes in general health status using the short-form 36 questionnaire 1 year following coronary artery bypass grafting.

OBJECTIVE: The problem addressed in the study was to gain a greater understanding of the health benefits of coronary artery bypass grafting (CABG). The purpose of the study was to assess general health status, using the short-form (SF)-36 questionnaire, approximately 12 months following CABG, and to document any associations between pre-operative health status, level of social support, coronary artery disease (CAD) risk factors, CAD symptom severity and post-operative health status. METHODS: The study was prospective and observational in design and included assessments at two time points, namely pre-operatively in a hospital outpatient department (1995-1996) and post-operatively at home (1996-1997). Two hundred and fourteen patients awaiting elective CABG were recruited a month before the expected date of operation. Pre-operative assessment included: (1), severity of symptoms; (2), CAD risk factors; (3), SF-36 questionnaire; and (4), social activities questionnaire. Post-operative assessment measured health status using the SF-36 instrument (mean, 16.4 months). Correlation and multiple linear regression analyses were used to identify factors associated with improved health status following CABG. RESULTS: Two hundred and fourteen patients were assessed pre-operatively and underwent CABG. There was a 4.8% 30-day mortality rate, and 183 patients were followed for a mean of 16.4 months after CABG. SF-36 scores following CABG were improved across all of the eight domains (P<0.001). A higher social network score and higher pre-operative health status were associated with improved health status. Patients with lower health levels (SF-36 scores) prior to CABG were less likely to gain improvement in health (SF-36 scores) following CABG. Lower SF-36 scores following operation were influenced by the presence of diabetes mellitus, cigarette smoking, younger age, a high socio-economic deprivation category and higher alcohol intake. Many patients had uncorrected CAD risk factors at pre-operative assessment. CONCLUSIONS: The SF-36 instrument was shown to be a useful and sensitive tool to assess differences and changes in the general health status of patients before and following CABG. High levels of social support were associated with improved health status post-operatively. Lower pre-operative general health status, the presence of diabetes mellitus and cigarette smoking were associated with poorer post-operative general health status.

Activities of Daily Living↗
PubMed2000

The evolving educational needs of nurses caring for the older adult: a literature review.

Recent changes in long-term care policies in the United Kingdom have resulted in many more older patients/clients, previously nursed in long-term hospital facilities, now being cared for in the community. This change has had a significant impact on nurses, forcing many to make the transition from working in hospital to within the community. This transition calls for appropriate professional educational preparation to enable these nurses to undertake their new roles effectively. The literature search that forms the basis for this paper revealed relatively little material focusing specifically on the educational needs of such nurses in transition. However, literature that addresses the needs of nurses caring for the older individual in the acute setting, and in the community environment, was found and is explored.

Aged↗
PubMed2000

The qualities of an effective mentor from the student nurse's perspective: findings from a longitudinal qualitative study.

Parker and Carlisle (Journal of Advanced Nursing 24, 771-778) argue that there is a scarcity of empirical research focusing on issues such as supernumerary status and mentorship in Project 2000 courses from the students' perspective. This paper presents the findings of a longitudinal cohort study using Grounded Theory to discover the effect(s) of mentorship on student nurses following the introduction of the 1992 programme of education leading to a Diploma of Higher Education in Nursing and registration with the United Kingdom Central Council (UKCC). The cohort consisted of 10 students from a large Scottish College of Nursing & Midwifery who were interviewed on five occasions during the three years of their course. Students also kept a diary to record their thoughts and experiences regarding mentorship during their practice placements. In addition, a further seven students volunteered to participate by diary only. Data were analysed with the aid of NUD.IST and subjected to the constant comparative method of analysis. Findings indicate that Diploma students quickly lose their idealistic view of their mentor and over time develop an insight into the qualities they perceive are required of an effective mentor. Students quickly become aware of the importance of choosing good role models and learning their own mentor's likes and dislikes as they realize this impinges on the outcome of their assessment. As students move into their Branch programme, a gradual distancing from their mentor is evident. This coincides with a development in their confidence, skills and a holistic perspective of care.

Education, Nursing↗
PubMed2000

Coronary artery disease patients' perception of their health and expectations of benefit following coronary artery bypass grafting.

This prospective descriptive study has analysed 214 patient interviews before and 1 year after coronary artery bypass grafting (CABG). The preoperative interview explored issues related to the impact of coronary artery disease upon health and expectations of benefit from the patients' perspective. The postoperative interview examined patients' accounts of the experience of operation and its impact on their health. A thematic analysis of the interview data was undertaken. The main factors relating to health status preoperatively were described in terms of 'dependency' on others and medication, and 'impending doom' of some major life threatening event. Benefits to health postoperatively were viewed in terms of 'removal of a death sentence' and 'freedom of choice'. Expectations of benefit from operation were varied and included 'freedom and independence', 'hope, chance and uncertainty' and 'addition of years to life and life to years'. Undergoing the operation was described by themes of the 'enormity of the experience' and 'the importance of lay support'. These findings provide a greater understanding of the 'lived experience' of both coronary artery disease and undergoing coronary artery bypass grafting. Unrealistic expectations of the benefits of CABG highlights the need for improvement in the way patients are informed about risks and benefits of interventions. In addition, the views and insights suggest that CABG operation is regarded as a significant major life event; thus more information, advice and counselling might help support patients before, during and after surgery.

Activities of Daily Living↗
PubMed2000

Acute menopause symptoms during adjuvant systemic treatment for breast cancer: a case-control study.

The purpose of this study was to ascertain whether acute menopause symptoms experienced by women with breast cancer differed from those of women experiencing a natural menopause. For the study, 200 women younger than 65 years of age receiving adjuvant systemic treatment for breast cancer were invited to complete a self-report questionnaire incorporating a previously validated tool: the Greene Climacteric Scale. The control group consisted of 200 women 50 to 64 years of age who did not have a breast cancer diagnosis. An overall response rate of 59.5% was obtained. The majority of the respondents were peri- or postmenopause at the time of the study, reporting either "irregular periods" or "no periods." Findings demonstrated that women receiving adjuvant systemic breast cancer treatment were more likely than the control group to report a current experience of menopause symptoms. Women with breast cancer also reported a higher incidence and severity of specific menopause symptoms (tiredness, hot flushes, night sweats) than control subjects. These differences remained statistically significant when controls were used for potential confounding variables such as age, menopause status, and time since last period. Hot flushes ranked second only to tiredness as side effects attributed to cancer treatments. Because of the intimate and supportive nature of their role, nurses are in a key position to conduct future research relating to women's experiences of menopause symptoms and potential therapeutic interventions. Within the specific context of breast cancer care, oncology nurses are recognized as having a central role in informing and supporting women throughout the breast cancer trajectory. Thus they are ideally placed to address menopause as a particular survivorship issue.

Acute Disease↗
PubMed1999

Prior knowledge of obstetric gestational age and possible bias of Ballard score.

OBJECTIVE: To determine whether prior knowledge of obstetric estimate of gestational age creates a bias in assignment of gestational age by the Ballard assessment score. METHODS: The Ballard assessment score was done on 82 infants weighing less than 2500 g by two examiners, one who had prior knowledge of best obstetric gestational age estimate and the other who was masked to that information. Obstetric gestational age was correlated with masked and unmasked score. Statistical analysis used Spearman rank correlation test, plotting the measurement means against the measurement differences, chi2, Wilcoxon signed-rank test, analysis of variance, and Student t test. Significance was assumed at P < .05. RESULTS: There was high reliability (r = 0.84-0.86) between obstetric gestational age estimates (33.3 +/- 3.0 weeks) and the gestational age derived from masked (34.3 +/- 3.0 weeks) and unmasked (34.0 +/- 3.0 weeks) Ballard scores. The mean difference between unmasked scores and gestational age was 1.38 +/- 1.15 weeks and that between masked scores and obstetric gestational age was 1.40 +/- 1.15 weeks, a nonsignificant difference. There was no significant difference in the number of cases with 100% agreement between masked and unmasked scores and obstetric gestational age or in the number of cases in which the score (masked or unmasked) differed by more than 2 weeks from obstetric gestational age. This study had over 99% power to detect a 1-week difference between the accuracy of masked and unmasked scores. CONCLUSION: Prior knowledge of obstetric gestational age did not bias the Ballard assessment score.

Bias↗
PubMed1999

Postoperative pain assessment and management in adolescents.

A 3-year study investigated the experience and management of postoperative pain following elective surgery in an adolescent sample, using a variety of valid, reliable instruments and semi-structured interviews. In addition to the adolescent subjects, the views of one parent of each adolescent were sought and a sample of health professionals comprising surgeons, anaesthetists and nurses were interviewed about acute pain in adolescent patients. This paper presents some of the main findings pertaining to pain assessment and management. Pain, experienced by most adolescents on the 1st and 3rd postoperative days, was influenced by the presence of anxiety and depression, in addition to the maturational stage; differences between in-patients and day cases are highlighted. Recommendations for practice include the need for more effective pain management and raising awareness of the importance of both psychological state and adjustment to adolescence in this age-group.

Adolescent↗
PubMed1999

A descriptive survey to identify the perceived skills and community skill requirements of mental health staff.

Throughout the 1990s mental health care has shifted from a hospital to a community-based service. Government policy indicates that staff require further education as a result of the shift to community care. However, none of the United Kingdom policy documents or mental health literature prescribes what education is required. Consequently this multidisciplinary study aimed to identify what skills, if any, were required by hospital-based staff to move to a community-based working environment. Study findings suggest advantages in perceiving skills as overlapping and interconnecting. Five common core skills and skill differences between professional groups are identified. It is argued that core skills are central and common to all groups and specialist skills are those that distinguish professional groups one from another and different grades of staff within professional groups. While problems of multidisciplinary education are considered, nevertheless a case is made for educating staff in core skills within a multidisciplinary environment which may be beneficial in achieving community care goals.

Community Mental Health Services↗
PubMed1999

The professional socialization of diploma of higher education in nursing students (Project 2000): a longitudinal qualitative study.

This paper presents a new theory of professional socialization in relation to diploma of higher education in nursing students (Project 2000). It was derived from a 3-year, grounded theory, longitudinal study exploring the effects of supernumerary status and mentorship on students undertaking practice placements. A purposive sample of 17 students was used. Ten students volunteered to be interviewed on five separate occasions throughout their course and to keep a diary to record their experiences of mentorship during their practice placements. Their diary acted as an aide memoir during their tape-recorded interviews. The other seven students participated by diary only and kept written accounts of their experiences of being supernumerary and having a mentor whilst on practice placements. Data were analysed with the aid of NUD.IST and subjected to the constant comparative method of analysis. Findings indicate that the mentor is the linchpin of the students' experience and that some students develop intuition much earlier than previous work has stated.

Education, Nursing, Baccalaureate↗
PubMed1998

Practice placement supervision: the role of the personal tutor.

Confusion regarding the role of the nurse teacher in clinical practice has resulted in a service being offered to students that varies in type, quantity and quality as perceived by students, teachers and placement staff alike: The role of the personal tutor is concerned with helping the students to develop both professionally and academically. To facilitate this, a good interpersonal relationship between student and personal tutor is essential. As interpersonal relationships take time to develop, the author advocates capitalizing on the relationship that (usually) already exists between personal tutors and students, and extending this into practice placement areas. The aim of this piece of research was to ascertain the value, as perceived by the students, of having the personal tutor supervise them in college as well as in the four branch placements of foundation studies. The methodology employed was a descriptive study utilizing a self-administered questionnaire. The population was the students in foundation studies of the Lothian College of Health Studies, and the sample was one of convenience, i.e. one cohort of students. The findings demonstrated that 55 students (n = 94) perceived value in having one nurse teacher supervising them in college and in placements compared with 39 students who did not perceive any value. The students were asked about their practice placement supervision by nurse teachers in terms of type, quantity and quality of teaching. The students in the former group rated their practice placement supervision much lower than students in the latter group.

Adolescent↗
PubMed1998

Satisfaction with midwife-managed care in different time periods: a randomised controlled trial of 1299 women.

OBJECTIVE: To compare women's satisfaction with midwife-managed care with 'shared care' over three different time periods. DESIGN: Randomised controlled trial. SETTING: Glasgow Royal Maternity Hospital, Glasgow, UK. PARTICIPANTS: 1299 women experiencing normal pregnancy (consent rate: 82%). Six hundred and forty-eight women were randomised to midwife-managed care and 651 to 'shared care'. METHODS: Three self-report questionnaires were sent to women's homes. The questionnaires examined: satisfaction with antenatal care at 34-35 weeks' gestation, and satisfaction with intrapartum, hospital- and home-based postnatal care at seven weeks postnatally. The third questionnaire reviewed satisfaction with intrapartum care seven months after delivery. FINDINGS: Women in both groups were satisfied. However, women in the midwife-managed group were more highly satisfied in relation to the dimensions examined: relationships with staff, information transfer, choices and decisions, and social support. The differences between the two groups were evident for all time periods (i.e. antenatal, intrapartum and postnatal periods) and were sustained at seven-month follow-up. This is illustrated in the mean scores for relationships with staff, as measured at 34-35 weeks' gestation (possible range -2; very negative attitudes to 2; very positive attitudes). Women in the midwife-managed group scored a mean of 1.22 compared to 0.74 for the 'shared care' group (mean diff: 0.48; 95% CI: 0.42 to 0.55). While women in both groups were more likely to make positive rather than negative comments in open-ended questions, the midwife-managed group were more likely to make positive comments whereas the 'shared care' group were more likely to make negative comments. CONCLUSION: Midwife-managed care for healthy pregnant women which is integrated into existing services improves satisfaction with antenatal, intrapartum and postnatal care.

Adult↗