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Biomedical subjects

P Rapley

Publications and source records attributed to P Rapley.

8 recordsLinked to original sources
PubMed2006

Surface dose measurement using TLD powder extrapolation.

Surface/near-surface dose measurements in therapeutic x-ray beams are important in determining the dose to the dermal and epidermal skin layers during radiation treatment. Accurate determination of the surface dose is a difficult but important task for proper treatment of patients. A new method of measuring surface dose in phantom through extrapolation of readings from various thicknesses of thermoluminescent dosimeter (TLD) powder has been developed and investigated. A device was designed, built, and tested that provides TLD powder thickness variation to a minimum thickness of 0.125 mm. Variations of the technique have been evaluated to optimize precision with consideration of procedural ease. Results of this study indicate that dose measurements (relative to D(max)) in regions of steep dose gradient in the beam axis direction are possible with a precision (2 standard deviations [SDs]) as good as +/- 1.2% using the technique. The dosimeter was developed and evaluated using variation to the experimental method. A clinically practical procedure was determined, resulting in measured surface dose of 20.4 +/- 2% of the D(max) dose for a 10 x 10 cm(2), 80-cm source-to-surface distance (SSD), Theratron 780 Cobalt-60 ((60)C) beam. Results obtained with TLD powder extrapolation compare favorably to other methods presented in the literature. The TLD powder extrapolation tool has been used clinically at the Northwestern Ontario Regional Cancer Centre (NWORCC) to measure surface dose effects under a number of conditions. Results from these measurements are reported. The method appears to be a simple and economical tool for surface dose measurement, particularly for facilities with TLD powder measurement capabilities.

Fluorides↗
PubMed2003

Reconstruction for chronic dislocation of the hip.

We analysed one surgeon's attempt to reconstruct the hip in 66 patients (84 hips) with chronic dislocation and to restore the height of the centre of rotation above the transverse teardrop line, the body-weight lever arm, the abductor lever arm, and the abductor angle to normal. The outcome was assessed using a patient profile at 0, 10 and 20 years, a clinical assessment of pain, mobility and the range of active movement. We measured the work done by active movement against gravity, radiological signs of loosening, migration and subsidence, and the need for revision. We used survival at ten years and revision as the endpoint. The incidence of complications was higher than in arthroplasty for primary osteoarthritis of the hip, but the outcome was considered satisfactory. The advantages of a flanged cemented socket were demonstrated. A custom-made, laterally reduced, Charnley extra small CDH femoral prosthesis was used in certain cases.

Adult↗
PubMed1999

Does the nursing diagnosis form the basis for patient care?

There is a growing level of activity supporting the development of a taxonomy for nursing diagnoses, interventions, and outcomes. While this development is occurring at a theoretical level, more work is necessary at a clinical level in order to determine how these concepts are being operationalized; more specifically, to establish whether there is a link between assessment, diagnosis and interventions documented in the patient's medical record. Using a retrospective audit this research reviewed 304 patient records. The study data revealed that the nursing diagnoses documented were not always supported by patient assessment information. It also illustrated inconsistent links between the documented nursing diagnosis and interventions. These findings challenge the a priori support for nursing diagnosis forming the basis for patient care, as it exposes clinical application weaknesses. Given the International Council of Nurses move to develop and evaluate an International Classification of Nursing Practice, these weaknesses need to be considered in any evaluation.

Decision Trees↗
PubMed1999

Self-efficacy in chronic illness: the juxtaposition of general and regimen-specific efficacy.

Changes in lifestyle are difficult for most people but necessary for those with a chronic illness, for whom changes may involve, among other adjustments, learning new behaviours and/or modifying one's lifestyle. The ease with which such changes occur depends on the person's efficacy beliefs and outcome expectations. This paper will discuss the conceptual issues related to self-efficacy: general, domain, and specific. Examples will be drawn from the health-related behaviour changes required to manage diabetes and rheumatoid arthritis. For this paper, regimen-specific or task-specific behaviour refers to the multiple tasks that the person carries out for management of their chronic illness. Confounding the issue of perceived efficacy (general, domain or specific), is the fact that compliance with all aspects of a recommended self-care regimen will not necessarily result in metabolic control for the person with type 1 diabetes mellitus, weight loss for the person with type 2 diabetes mellitus, or pain control for the arthritic person.

Adaptation, Psychological↗
PubMed1990

Justifying nursing practice: the scientific rationale.

The development of theories underlying the scientific basis for the performance of nursing care begin with sufficient curiosity to enable the exploration of the relationships between practice and outcome. For any one problem, a sound scientific rationale reflects not only 'how' (strategy), but 'why' (topic) a particular action has been chosen to resolve a particular problem and, in addition, clearly demonstrates the relationship of these elements in the light of patient assessment and nursing diagnosis.

Curriculum↗
PubMedDate not supplied

Adapting to diabetes: metabolic control and psychosocial variables.

The purpose of this study was to examine the influence of hardiness, self-efficacy, coping style and psychosocial adaptation to illness on the metabolic control of insulin dependent and non-insulin dependent subjects. After adjustment for age, gender and diabetes type the best predictors for insulin dependent diabetics were found to be hardiness and psychosocial adjustment, and for non-insulin dependent diabetics, psychosocial adjustment alone. No interaction effect was found between the variables. Self-efficacy and coping skills were not found to predict metabolic control.

Adaptation, Psychological↗
PubMedDate not supplied

Self-care: re-thinking the role of compliance.

This paper argues for a research approach that recognises that people make choices about their compliance to medical regimens according to their own perceptions of their needs, regardless of whether these conform to professionals' perceptions of needs. This approach requires an acceptance of a construction of reality that allows for personal experience to be accepted as having a truth of its own. The relationship between a reconstructed conceptualisation of self-care and the emancipation and empowerment of people with chronic illnesses is discussed.

Choice Behavior↗