Promoting cost effective prescribing. Cost effectiveness studies may not be cost effective.
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Cost-Benefit Analysis↗
Biomedical subjects
N Wells
Publications and source records attributed to N Wells.
Perceived control over pain: relation to distress and disability.
The relationship between perceived control over pain and outcomes of distress and disability were studied in a sample consisting of 71 patients with chronic nonmalignant pain. The pain-related control belief subscales measured three aspects of control: lack of control, ability to cope, and negative outcome expectancy. After controlling for pain intensity, the control belief subscales explained a significant amount of the variance in distress and disability. These findings provide support for cognitive modulation of the distress and disability associated with chronic nonmalignant pain.
Adaptation, Psychological↗
A survey of practicing nurses' research interests and activities.
We conducted a survey of 279 practicing nurses' research attitudes, past and current research activities, and research resources. Levels of practice included staff nurses, nurse managers, and advanced practice nurses. Three factors were identified from a 15-item research attitudes scale: research value, confidence, and perceived support. Significant differences were found for research value and confidence among three levels of clinical practice. Advanced practice nurses reported higher research value and confidence than did staff nurses and nurse managers. Most respondents reported using research findings in practice, but only a small percentage were conducting research. Factors related to research conduct and use differed. Suggestions are offered for methods to increase the value of research by practicing nurses.
Adult↗
Dosimetry of effective wedge fields produced by an internal wedge.
A procedure is described to calculate the monitor unit ratios required to produce effective wedge fields having a desired wedge angle by combining an internal 60 degrees wedge with an open field. Complementary procedures are derived and demonstrated for calculating the effective wedge dose distributions with wedge angles of 15 degrees, 30 degrees, and 45 degrees using the central axis depth dose data and off-axis ratios of the open field and the 60 degrees wedged field. Measurements at five points on and off the central axis within each field and measurements of the effective wedge factor demonstrated that the calculated wedge distributions were correctly delivered to within 2% in all cases.
Biophysical Phenomena↗
A national survey of asthma prevalence, severity, and treatment in Great Britain.
Parents of 5472 children aged 5-17 years from 3209 families were interviewed in a nationwide household survey. In the past year, 15.0% of children had wheezed, 2.2% had more than 12 attacks, and 2.3% had experienced a speech limiting attack. Altogether 4.3% were woken more than once a week by wheezing, 13.1% had doctor diagnosed asthma, and 13.6% had been prescribed antiasthmatic drugs in the past year. With increasing age, morbidity related to wheezing declined to a greater extent than annual period prevalence. The prevalence of wheeze varied little by socioeconomic group, but there were marked trends in all three indices of severity towards increased morbidity in poorer families. Diagnostic labelling and drug treatment of wheezy children did not differ substantially with socioeconomic status. Thus, a degree of socioeconomic equality exists in the process of medical care for childhood asthma in Britain. This does not appear to have resulted in equality of outcome.
Adolescent↗
Different motion sensitive units are involved in recovering the direction of moving lines.
We studied direction discrimination for lines moving obliquely relative to their orientation. Manipulating contrast, length and duration of motion, we found systematic errors in direction discrimination at low contrast, long length and/or short durations. These errors can be accounted for by a competition between ambiguous velocity signals originating from contour motion processing units and signals from line terminator processing units. The dynamic of this competition can be described by a simple model involving two different classes of processing units with different contrast thresholds, different integration time constants and different levels of response saturation.
Computers↗
The real costs of emesis--an economic analysis of ondansetron vs. metoclopramide in controlling emesis in patients receiving chemotherapy for cancer.
The cost effectiveness of ondansetron was compared with that of metoclopramide in the prevention of acute emesis due to highly emetogenic chemotherapy in an open, randomised, parallel group pilot study. Ondansetron was given as three 8 mg intravenous doses (0, 4 and 8 h) and metoclopramide as an intravenous loading dose (3 mg/kg) followed by a maintenance dose of 0.5 mg/kg/h for 8 h. Therapeutic outcomes and full utilisation costs, that is nursing time, material costs, in addition to drug acquisition prices were recorded for each antiemetic for 24 h following chemotherapy. The cost per successfully treated patient (< or = 1 emetic episode and no adverse events) was 95.20 pounds for ondansetron and 92.18 pounds for metoclopramide. The results of the study therefore suggest that for the control of acute emesis due to highly emetogenic chemotherapy ondansetron and metoclopramide are equally cost-effective treatments.
Antineoplastic Agents↗
A comparison of the costs of ceftazidime therapy and gentamicin combinations in three UK hospitals.
This study compares the utilization costs of ceftazidime therapy with those of gentamicin in combination with other antibacterial drugs. The results show that the relatively high purchase cost of ceftazidime compared to combinations is more than counterbalanced by the additional materials used for drug administration and serum antibiotic assays, even when other drugs were combined with ceftazidime. The average drug and equipment costs were 230.13 pounds for ceftazidime regimens and 253.94 pounds for gentamicin regimens. It is also shown that ceftazidime therapy is associated with a reduction in personnel time compared to gentamicin regimens. The average times per patient for administration and assay were 1 h 43 min for ceftazidime and 4 h 57 min for gentamicin regimens. We conclude that ceftazidime regimens are cheaper than gentamicin regimens when all drug and equipment costs are quantified. Moreover, the use of ceftazidime will release staff time for other purposes.
Anti-Bacterial Agents↗
Reducing distress during abortion: a test of sensory information.
The purpose of this study was to examine the effect of providing sensory information on distress during first-trimester abortion using a 2 x 2 factorial design. The factors were type of information given and type of anaesthesia used. Eighty-four women completed pre-abortion measures of state anxiety, and subjective pain and distress. Post-abortion measures included behavioural distress, subjective distress, pain and state anxiety. No significant differences were found for type of information (sensory vs. general) received on subjective or behavioural distress measures. Women receiving intravenous sedation together with local cervical block reported less subjective distress and pain than women receiving local anaesthesia alone. Sensory information was not effective in reducing distress during abortion.
Abortion, Legal↗
A comparison of models describing reports of disability associated with chronic pain.
We examined pain-related disability from two perspectives. A disability model, suggesting that disability is a direct consequence of pain, is compared with a symptom perception model emphasizing individual differences in perception and report of physical symptoms. Disability estimates (reported activity interference and employment status) were obtained from a sample of 179 patients with chronic pain. Using multiple regression analyses, we showed that distress, symptom reporting, and pain intensity accounted for comparable levels of variance in reports of activity interference. When we controlled for distress, the frequency of reporting physical symptoms made the largest contribution to prediction of this kind of disability (14%). Neither symptom report or pain intensity was useful in predicting the more objective disability criterion of employment status. Results were interpreted as probable evidence against a disability model of pain-related disability and suggest the relative importance of individual cognitive differences in symptom responsivity.
Activities of Daily Living↗
The assessment of pain in children.
This article focuses on the methods of pain measurement and assessment in children. The concepts of reliability and validity and the available types of physiologic, self-report, and behavioral measures are addressed. Methods of pain assessment in infants and toddlers, preschoolers, school-aged children, and adolescents are detailed. Finally, some practical suggestions for pediatric pain assessment are provided.
Adolescent↗
Management of pain during abortion.
The purpose of this study was to determine the effects of three cognitive behavioural strategies in the management of abortion pain. The interventions were drawn from the multidimensional model of pain suggested by the gate control theory. Forty patients undergoing abortion with local anaesthesia were instructed in one of four interventions: relaxation, pleasant imagery, analgesic imagery, and a pain discussion (attention control) group. Pain was measured using Johnson's two-dimensional graphic rating scales labelled sensation and distress. Speed of recovery and analgesic use were included as objective dependent measures. No significant differences were found among the four groups on any dependent measures although subjects receiving the pleasant imagery intervention reported the lowest subjective ratings of pain sensation and distress. Findings are discussed in terms of past research and implications for the management of acute pain experienced during abortion.
Abortion, Therapeutic↗
Cognitive behavioural strategies in pain management.
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Adaptation, Psychological↗
Nurses' attitudes toward the advantages of master's degree preparation in nursing.
The first objective of this study was to measure attitudes and opinions regarding master's degree preparation in nursing. The second objective was to identify important characteristics of graduate nursing education programs. The researcher developed Educational Attitude Questionnaire was mailed to a random sample of members of the Association of Rehabilitation Nurses and the Oncology Nursing Society. Five hundred twenty-four completed questionnaires were used for data analysis. Study findings revealed the bachelor's prepared nurses surveyed held a generally positive attitude toward graduate education in nursing. Fifty percent of the subjects indicated an intention to obtain a masters degree in nursing. For the majority of subjects the characteristics of graduate programs considered most important included faculty with high academic standards who offer challenging specialty area programs on a flexible time schedule.
Adult↗
Effects of preoperative teaching on postoperative pain: a replication and expansion.
This study was designed to test the effectiveness of brief relaxation training on postoperative pain, replicating and extending a study of Flaherty and Fitzpatrick (1978). A two-group pre- and post-test experimental design was used to determine if vital signs, analgesic consumption, anxiety, self-reported incisional pain sensation and distress differ in postsurgical patients who have or have not received relaxation training. Seventy-two adult, elective abdominal surgery patients were randomly assigned to treatment groups. Subjects in both groups were visited on the eve of surgery. Experimental subjects were taught a relaxation technique. Equal time was spent with control subjects. Following surgery all subjects were observed during ambulation. Vital signs were measured pre- and postoperatively, as were self-report of pain sensation and distress. Results showed that distress caused by painful sensations was significantly lower for experimental subjects (F (1, 53) = 4.69, p = 0.03). Vital signs, analgesic consumption and self-reported pain sensation were not altered by relaxation training. These findings only partially agree with those of Flaherty and Fitzpatrick. Additional analyses by type of surgery (cholecystectomy and hysterectomy) showed hysterectomy subjects reported less pain sensation and distress and used less analgesics than cholecystectomy subjects.
Adult↗
Responses to acute pain and the nursing implications.
Management of acute pain offers many techniques--peripherally, to reduce the sensory input from the nociceptors and ascending fibres, and centrally by altering cognition, evaluation and emotional arousal to the sensory input. Scientifically-based nursing intervention is imperative. Therefore, nurses needed a better understanding of recent research regarding pain. As well, recognition that all individuals express and cope with pain in different ways, and therefore exhibit different pain behaviours, is necessary if effective nursing care is to be given. Finally, with all the interacting variables and methods of intervention available, pain medication should never be the only intervention used for the patient with pain.
Affect↗
Radiation exposure to the family of radioactive patients.
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Angina Pectoris↗
Pain and distress during abortion.
Although there has been recent emphasis on the long-term effects of abortion on women, the distressing aspects of the procedure itself are seldom addressed. The pain and distress experienced by 35 women undergoing first-trimester abortion were addressed. The quality and intensity of pain were measured using the McGill Pain Questionnaire (MPQ) and a pain intensity visual analog scale (VAS). Distress measures included a VAS, state anxiety, observation of behavior, and observer-rated distress. The women reported elevated levels of state anxiety before the abortion and pain and distress during the procedure. The pattern of verbal descriptors on the MPQ was comparable to previously reported descriptors of abortion, labor, and menstrual pain. The MPQ dimension scores did not differ by type of anesthesia received. Findings indicate that first-trimester abortion is a painful and distressing medical procedure and support the use of the MPQ as a measure of the character and intensity of the pain experienced.
Abortion, Legal↗