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Pamela Smith

Publications and source records attributed to Pamela Smith.

11 recordsLinked to original sources
PubMed2005

Developing an interprofessional learning culture in primary care.

This paper discusses the concept of interprofessional learning based on empirical data from an evaluation of an interprofessional learning project that was set in a British primary health care centre. A process evaluation methodology was chosen to collect the data using semi-structured interviews and focus groups with stakeholders and staff to gather their experiences and views of the project and documentary data from records written over the lifetime of the project. The paper argues that an interprofessional learning culture requires time to become embedded in everyday practice and to achieve such a culture, shared values, aims and clear communication are essential. The data suggest that there is a need to recognize responsibility for one's own learning as individuals as well as learning as teams of work colleagues if interprofessional learning is to be successful. However, even when these pre-requisites of interprofessional learning are agreed and acknowledged openly in the workplace, participants in the development of a learning culture need to recognize that there are structural controls which influence and constrain such developments which are external to participants and beyond their immediate control.

Community Health Nursing↗
PubMed2003

Satisfaction with medical rehabilitation in patients with orthopedic impairment.

OBJECTIVE: To examine patient satisfaction after orthopedic impairment at 80 to 180 days after inpatient rehabilitation. DESIGN: Retrospective design examining records from facilities subscribing to the Uniform Data System for Medical Rehabilitation (UDSmr). SETTING: Information submitted to UDSmr from 1997 to 1998 by 177 hospital and rehabilitation facilities from 40 states. PARTICIPANTS: The sample (N=7781) was 72.63% female and 88.60% non-Hispanic white, with a mean age +/- standard deviation of 73.07+/-11.81 years, and average length of stay (LOS) of 13.84+/-10.48 days. INTERVENTION: Usual rehabilitation care. Main outcome measures Level of satisfaction 80 to 180 days after discharge as well as motor, cognitive, and subscale ratings for the FIM trade mark instrument. Predictor variables included gender, age, English language, marital status, discharge setting, LOS, rehospitalization, FIM gain, and primary payer. RESULTS: A logistic regression model was used to predict patient satisfaction at follow-up. Five statistically significant (P<.05) variables were found and correctly classified 94.9% of the patients. Discharge motor FIM rating, rehospitalization, age, patient's primary language, and discharge setting were associated with increased satisfaction. Discharge motor FIM ratings were significantly associated with increased satisfaction in patients with joint replacements and lower-extremity fractures. CONCLUSION: unctional and demographic variables were identified as predictors of satisfaction in patients with orthopedic impairments.

Aged↗
PubMed2003

Treatment of difficult-to-control blood pressure in a multidisciplinary clinic at a public hospital.

Cardiovascular morbidity and mortality in disadvantaged populations remains high. Few innovative strategies or services to treat chronic diseases have been critically analyzed in these patients. We evaluated our initial experiences with a newly established multidisciplinary clinic For the treatment of difficult-to-control hypertension and describe reasons for poor blood pressure control as well as treatment strategies. Patients with blood pressures greater than 140/90 despite concurrent treatment with three or more medications for at least three months were referred to our clinic. Data regarding sociodemographic characteristics, health beliefs and behaviors were collected. Two physicians jointly proposed an explanation for lack of blood pressure control. A multidisciplinary team of physicians, nurses, pharmacists, and nutritionists aggressively assessed and reinforced educational objectives tailored to individual needs. 58% of patients achieved target blood pressure at six months, but 22% were lost to follow-up. The most common reasons for previous treatment failure were volume overload and poor medication adherence. We conclude that a multidisciplinary clinic for difficult-to-control blood pressure can be successful in a large, urban hospital serving a disadvantaged minority population. However, more study is needed to delineate the specific reasons for success and further refine treatment strategies.

Adult↗
PubMed2003

A connectionist account of Spanish determiner production.

Evidence from experimental studies of Spanish children's production of determiners reveals that they pay more attention to phonological cues present in nouns than to natural semantics when assigning gender to determiners (Pérez-Pereira, 1991). This experimental work also demonstrated that Spanish children are more likely to produce the correct determiner when given a noun with phonological cues which suggest it is masculine, and more likely to assign masculine gender to nouns with ambiguous cues. In this paper, we investigate the phonological cues available to children and seek to explore the possibility that differential frequency in the linguistic input explains the priority given to masculine forms when children are faced with ambiguous novel items. A connectionist model of determiner production was incrementally trained on a lexicon of determiner-noun phrases taken from parental speech in a longitudinal study of a child between the ages of 1;7 and 2;11 (López Ornat, Fernandez, Gallo & Mariscal, 1994) preserving the type and token frequency information. An analysis of the database of parental productions revealed that while regular feminine nouns were slightly more frequent than regular masculine nouns, irregular masculine nouns outnumbered irregular feminine nouns by roughly 2 to 1. On the basis of this, we made the prediction that as the training lexicon builds up, the network will perform better overall on masculine determiners than would be predicted from their forms alone and will tend to assign masculine gender to ambiguous novel nouns in a test set. The findings indicate that, at least in the case of Spanish gender agreement for determiners and nouns, a general associative learning mechanism can account for important characteristics of the acquisition process seen in children.

Child↗
PubMed2002

Characterization of visual phenomena with the Array multifocal intraocular lens.

PURPOSE: To characterize the visual sensations reported after bilateral implantation of the Array multifocal intraocular lens (IOL) (Allergan Surgical) and evaluate the means to mitigate unwanted visual sensations. SETTING: Surgery centers in Kansas City, Missouri, and Lake Worth, Florida, USA. METHODS: A retrospective parallel-group assessment of subjective nighttime visual sensations was conducted in 22 patients who had bilateral implantation of the Array multifocal IOL. Thirteen patients were recruited from a small subset of patients who were dissatisfied with the Array because of unwanted visual sensations (UVS group). The parallel group included 9 patients who were satisfied with the Array and not bothered by visual sensations (satisfied group). The primary endpoint was the patient's characterization of visual phenomena under simulated nighttime conditions. The secondary endpoint was the effect of adding trial lenses of -0.50 diopter (D) and -1.00 D to the patient's distance spectacle correction. RESULTS: Most patients reported that the simulation produced visual sensations similar to their real-life experiences. Patients in the UVS group reported the visual sensations as large starbursts and somewhat spoke-like starbursts with fine lines. Patients in the satisfied group reported them as blurred large or small starbursts. A few reported a color variance and finer quality to the starburst in real life. Visual phenomena were generally mitigated by the addition of a -0.50 D or -1.00 D lens. CONCLUSIONS: Both study groups reported similar visual phenomena. The difference between those who were bothered by the visual sensations and those who were not appears to be a function of individual tolerance. The visual sensations may be mitigated with minus-lens overcorrection.

Aged↗
PubMed2002

Intraocular lens and corneal status following aircraft ejection by a USAF aviator.

Prior to 1967, military aviators who developed visually significant cataracts that affected visual performance were grounded. Those that ultimately required surgical removal were permanently grounded because of significant optical effects post-operatively. With the advent of contact lenses, a limited number of aircrew were returned to the cockpit because of improved optical factors provided by contacts post-cataract surgery. However, development of the intraocular lens (IOL) in the 1970s marked a major technological breakthrough that provided the potential to restore post-cataract surgical vision to near normal conditions. This case report is the first known occurrence of ejection from a high performance militaryaircraft by an aviator with an IOL. The success and stability of the IOL through this event provided additional clinical and operational information relative to the overall USAF experience with certain types of IOL approved for use in USAF aircrew. The aviator also sustained unexpected corneal foreign bodies due to the canopy fragmentation system.

Adult↗
PubMedDate not supplied

The use of intradialytic parenteral nutrition to treat malnutrition: a case study.

Protein energy malnutrition in dialysis patients has been well-described in the literature. Most malnourished patients with end stage renal disease (ESRD) suffer from a mixed marasmus-kwashiorkor type of malnutrition with loss of both somatic and visceral protein mass. Malnutrition is associated with increased risk of morbidity and mortality. Up to 50% of patients on dialysis have protein energy malnutrition (Mortelmans & Vanholder, 1999). Malnutrition may be under-recognized and under-reported in dialysis patients. Malnutrition may result from inadequate food intake secondary to the uremic condition, nausea, vomiting, loss of appetite, altered taste and other physiologic conditions that impede food intake or metabolism. The usual indices of nutritional assessment--body weight, body mass index (BMI), anthropometrics, etc., may be inaccurate in patients with ESRD, as the results are often skewed by fluid retention. Therefore, we often rely on weight loss, bloodwork, a pre-dialysis low serum potassium, phosphorus and urea, as early signs of a decreased food intake. When patients are malnourished, measures such as oral supplements and/or tube feedings may be used to augment protein and calorie intake. However, when these interventions are inadequate to reverse the malnutrition condition, intradialytic parenteral nutrition (IDPN) should be implemented. Although there is no definite supportive data to show that the use of IDPN improves morbidity and mortality of dialysis patients, there are data to support that IDPN has positive effects on numerous nutritional parameters (Acchiardo, 2000; Capelli et al., 1994; Foulks, 1999; Hiroshige et al., 1998; Ikizler et al., 1995; Korzets et al., 1999; Mortelmans & Vanholder, 1999; Saunders et al., 1999; Smolle et al., 1995). In this article, we will discuss the causes of malnutrition in dialysis patients, the use of IDPN on one of our patients, and the potential complications associated with IDPN.

Body Weight↗