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Biomedical subjects

M C Shaw

Publications and source records attributed to M C Shaw.

16 recordsLinked to original sources
PubMed2003

Development of an evidence-based algorithm for the management of ovarian cancer.

OBJECTIVE: To describe the management of ovarian cancer to be undertaken by a gynaecologist and to describe the highest level of primary research evidence supporting it. DESIGN: Use of regional guidelines and semi-structured interviews with gynaecological oncologists to devise a flow-chart algorithm for management. Use of an algorithm to identify the key research questions and to define search strategies for primary research, which was assessed using pre-defined criteria for validity. MAIN OUTCOME MEASURES: Highest level of evidence for each research question based on the design of the valid studies. RESULTS: Prospective cohort studies (level II-2A) support the algorithm's diagnostic procedures. The evidence for accurate staging is derived from case series data (level II-2B). Preserving the uterus in young women wishing to maintain fertility is supported by prospective cohort studies (level II-2A) and by case series data (level IV) for women with germ cell tumours. Prospective cohort studies (level II-2A) support surgical management with hysterectomy, bilateral oophorectomy and debulking. The evidence for chemotherapy comes from randomised controlled trials (level I), except for germ cell tumours where the evidence was from case series data (level IV). CONCLUSIONS: The management of ovarian cancer and the level of evidence supporting it can be described using a flow-chart algorithm. Evaluations of whether this presentation helps consultants follow guidelines are required.

Adolescent↗
PubMed2003

Development of an evidence-based algorithm for the management of cervical cancer.

OBJECTIVE: To develop a description of the management of cervical cancer to support locally developed, regional guidelines and to identify the level of primary research evidence to support it. DESIGN: Development of a flow-charted algorithm, using regional guidelines and clinician consensus. A Medline literature search for primary research was done to validate the algorithm and selection of papers, to verify if they were valid according to pre-defined criteria and to compare algorithm management with an alternative. MAIN OUTCOME MEASURE: The highest level of evidence for algorithm management was based on the design of the supporting research. RESULTS: Twenty percent of the algorithm is supported by level I evidence (randomised controlled trials), 70% by level II evidence (cohort studies) and 10% by level IV evidence (expert opinion or case series). Level II evidence supports the management of Stage Ia, squamous cell carcinoma by cone biopsy or a simple hysterectomy. This level of evidence also applies to research on the management of Stages Ib-IIa, by radical hysterectomy and pelvic lymphadenectomy followed by radiotherapy, if the lymph nodes are positive. Radiotherapy to treat Stages IIb-IV cervical cancer is supported by level I evidence. The management of Stage I adenocarcinoma is supported by level II evidence. CONCLUSIONS: Evaluations of the effect of informing clinicians of the strengths of the proposed management are now required, as constructing evidence-based algorithms is worthwhile, only if they are likely to affect clinical practice.

Adenocarcinoma↗
PubMed1993

The discipline of nursing: historical roots, current perspectives, future directions.

As advances in nursing science and research impact upon nursing education and clinical practice, new ways of looking at phenomena have led to a re-examination and refinement of the traditional concepts: person, environment, health and nursing. This evolving pattern of intellectual growth holds promise for the discipline of nursing through the advancement of knowledge based upon scientific inquiry into the practice of nursing. This paper discusses nursing as a discipline by examining the development of a unique body of knowledge from three viewpoints: historical past, current perspectives and future direction.

Community Participation↗
PubMed1992

The family, crisis and chronic illness: an evolutionary model.

While chronic illness has a profound impact upon the individual, an immense burden is imposed upon the family. When the competing demands of an illness and the family escalate exponentially, there may be a crisis. Traditionally, crisis theory has been applied to acute care contexts such as emergency, intensive care and mental health nursing. Yet, clinical experience with families and chronic illness supports the notion of periodic crises from the prediagnostic phase to the long-haul of the illness. Moreover, the authors hypothesize that the family's perception of the event determines whether the crisis is perceived as a threat or a challenge. This paper thus addresses the perception of crisis within the framework of chronic illness from a biological and family systems nursing perspective. First, the theory of Humberto Maturana, a Chilean biologist, is explored and applied to clinical observations regarding family, crisis and chronic illness. Second, an evolutionary model for conceptualizing crisis and chronic illness is presented. Third, the role of beliefs in the family perceptions of crisis and chronic illness is discussed.

Adolescent↗
PubMed1984

Liquid chromatographic assay for diflorasone diacetate in cream and ointment formulations.

A high-performance liquid chromatographic assay for quantitating diflorasone diacetate (I) in cream and ointment formulations and in bulk form is described. Isoflupredone acetate (II) was used as the internal standard and a 3-micron silica gel column with a mobile phase comprised of water-saturated butyl chloride-water-saturated methylene chloride-tetrahydrofuran-acetic acid (350:125:10:15) led to an efficient separation. The method gave accurate results for four formulations, two creams and two ointments, as well as the bulk drug. The assay has an RSD of approximately 1.8% for the cream formulations, 1.3% for the ointment formulations, and 1.0% for the bulk drug. The method is specific for I and capable of resolving structurally related compounds.

Betamethasone↗