Biomedical subjects

Patricia Davidson

Publications and source records attributed to Patricia Davidson.

24 records · Page 2Linked to original sources

PubMedDate not supplied

Polycaprolactone-block-poly(ethylene oxide) micelles: a nanodelivery system for 17beta-estradiol.

Various hormone replacement regimens and delivery systems have been developed; however, there is still a need for additional, easily controllable and biocompatible systems. We have developed and characterized biocompatible polycaprolactone-block-poly(ethylene oxide) (PCL-b-PEO) micelles for the delivery of 17beta-estradiol (E2) and investigated their loading and release properties using fluorescence spectroscopy. The micelles are spherical aggregates that range in size from 20 to 40 nm, as determined by both transmission electron microscopy and dynamic light scattering. A high loading efficiency for E2 of up to 96%, as well as a high drug loading capacity of up to 4000 molecules of E2 per micelle (equivalent to 190% (w/w)), is obtainable. In addition, the E2 loading and release can be controlled by modifying the block length of the polycaprolactone core and the initial estradiol concentration. The release of E2 from the micelles showed a biphasic profile under perfect sink conditions: there is an initial burst release, followed by a slow and prolonged release for up to 5 days, until complete release is achieved. The release of E2 from the micelles was shown to be diffusional, as shown by the linearity of the release as a function of the square root of time. Approximate diffusion coefficients of the order of 10(-17) cm2/s were obtained. In vitro and in vivo experiments confirmed that the biological activity of E2 was retained after preparation of the micelles. This micelle carrier could serve as a versatile and efficient nanodelivery system for steroids and other poorly water soluble drugs that require solubilizing agents for delivery.

Animals↗

PubMedDate not supplied

Patient-centered needs assessment: rationale for a psychometric measure for assessing needs in heart failure.

Determining an individual's unique perspective of an illness experience remains a challenge for clinicians, administrators, and researchers. A range of concepts and psychometric measures have been developed and evaluated to capture this information. These include patient satisfaction, quality of life, and utility measures. Needs assessment as a tool for evaluating perceptions of health status and determining patient satisfaction and treatment plans has been explored in oncology. Studies have demonstrated that a high proportion of patients have unmet needs in relation to activities of daily living, information sources, and comfort. Heart failure (HF), a condition with significant individual and societal burden, mirrors the illness of experience of cancer, as individuals process issues related to prognosis, treatment regimens, and decreased functional status. A needs-based assessment of health status, expectations, and perceptions is patient-centered and has the capacity to not only evaluate current health status but also plan and project care plans. Needs assessment is a dynamic construct rather than a point in time consistent with other assessment modalities, such as quality of life. Multidimensional needs assessment allows for planning and projection of needs, not only on an individual but also a population basis. Implicit in the exploration of needs is an expectation of level of care to be provided, from both the provider and recipient of care. In many instances a misalignment may exist between services and resources available to the individual. This article seeks to provide a theoretical justification for the development of a needs assessment instrument for patients with HF and to discuss the rationale of this method of assessment to create better alignment and resources with patients needs and expectations.

Colonic Neoplasms↗

PubMedDate not supplied

Persistence of coronary risk factor status in participants 12 to 18 months after percutaneous coronary intervention.

BACKGROUND: Percutaneous coronary intervention (PCI) is a widely performed revascularization technique for coronary heart disease; however, there is limited research investigating the risk factor status of patients 1 year after the procedure. OBJECTIVE: This cross-sectional study was conducted to investigate the self-reported risk factor status by patients who had undergone a PCI at a major teaching hospital in Sydney, Australia. SUBJECTS: : Two hundred seventy participants who underwent PCI between April 2003 and March 2004 and who met the inclusion criteria were followed up 1 year after the PCI. METHODS: After obtaining informed consent, a follow-up self-administered questionnaire was mailed to participants. Information was collected relating to the following coronary risk factors: smoking, and physical activity status, blood pressure and cholesterol levels, body mass index, depression, anxiety, and stress levels. RESULTS: Two hundred two participants (75%) returned a completed questionnaire. Approximately one third of participants had at least two modifiable risk factors. The most common cardiovascular risk factors identified were physical inactivity, increased body mass index, high blood pressure, and high cholesterol. Approximately half the women (46%) and a quarter of the men had at least two modifiable risk factors. Only a minority (11%) of the participants continued to smoke at 1-year follow up. Participating in physical activity for a total time of 150 minutes or more per week was reported by only 42% of the participants. Depression and anxiety were present in 25% and stress in 17% of the participants. A third of the participants (n = 64) erroneously believed that they had no heart problems. CONCLUSIONS: The findings reveal inadequate management of modifiable risk factors among post-PCI participants 12 to 18 months after revascularization, which highlights a need for tailored secondary prevention interventions to address factors contributing to cardiovascular risk. The evidence obtained from this study will inform the development of an intervention to address cardiovascular risk factor modification.

Adult↗

PubMedDate not supplied

Community health nursing in Australia: a critical literature review and implications for professional development.

BACKGROUND: Increasing emphasis on community-based mandates an examination of the community health nurse (CHN). AIM: A critical literature review of the CHN role internationally, with an emphasis on Australia, was undertaken in order to understand historical precedents and inform policy and strategic directions for the CHN. METHOD: A search of the CINAHL, EMBASE, and COCHRANE electronic data-bases from 1982 to June 2002 using community' and 'nursing' as key words and hand searching of books and government reports was undertaken. FINDINGS: This search strategy revealed a lack of literature compared with other areas of nursing. Key themes emerging from this review are: (1) an absence of clear role definitions and lack of clarity of roles; (2) variability in educational requirements for CHNs; (3) diminished CHN power in policy decision making; (3) conflicting role expectations between different facets of the health care system; (4) underutilisation and untapped potential of the role of the CHN in the contemporary health care system; (5) the emerging influence of specialist nurses in community based-care; (6) uptake of traditional nursing roles by non-nurses and (7) an absence of a cohesive model of professional development of CHN that is able to articulate with contemporary social, political and economic trends in health care delivery. CONCLUSIONS: Community health nursing in Australia has a low professional profile when compared to other nursing specialties. An emerging issue, gleaned from the literature review is the tension and debate between specialist and generalist services. It is apparent from this review that CHN have to more actively participate in research and peer reviewed debate in order to have their voice heard and promote their unique and valuable contribution to the nursing profession and the health care system.

Australia↗

PubMedDate not supplied

Using the illness trajectory framework to describe recovery from traumatic injury.

This paper seeks to highlight the utility of the Corbin and Strauss Chronic Illness Trajectory Framework in describing recovery from traumatic injury and encourages consideration of its implementation into contemporary trauma nursing (Corbin and Strauss, 1991; 1992). To date, few such frameworks have been proposed to sensitize health professionals to the path of recovery following traumatic injury. Although this framework was initially conceived for use in the domain of chronic illness, the lasting effects of severe traumatic injury have significant parallels to chronic conditions such as stroke (Burton, 2000) and multiple sclerosis (Miller, 1993) to which the framework has previously been applied. This paper demonstrates the Trajectory Framework as a useful structure to potentially enhance the development of post-discharge interventions for trauma survivors and encourages consideration of its implementation into the nursing management of this complex patient group.

Chronic Disease↗

PubMedDate not supplied

Beyond the rhetoric: what do we mean by a 'model of care'?

BACKGROUND: Contemporary health care systems are constantly challenged to revise traditional methods of health care delivery. These challenges are multifaceted and stem from: (1) novel pharmacological and non-pharmacological treatments; (2) changes in consumer demands and expectations; (3) fiscal and resource constraints; (4) changes in societal demographics in particular the ageing of society; (5) an increasing burden of chronic disease; (6) documentation of limitations in traditional health care delivery; (7) increased emphasis on transparency, accountability, evidence-based practice (EBP) and clinical governance structures; and (8) the increasing cultural diversity of the community. These challenges provoke discussion of potential alternative models of care, with scant reference to defining what constitutes a model of care. AIM: This paper aims to define what is meant by the term 'model of care' and document the pragmatic systems and processes necessary to develop, plan, implement and evaluate novel models of care delivery. METHODS: Searches of electronic databases, the reference lists of published materials, policy documents and the Internet were conducted using key words including 'model*', 'framework*', 'models, theoretical' and 'nursing models, theoretical'. The collated material was then analysed and synthesised into this review. RESULTS: This review determined that in addition to key conceptual and theoretical perspectives, quality improvement theory (eg. collaborative methodology), project management methods and change management theory inform both pragmatic and conceptual elements of a model of care. Crucial elements in changing health care delivery through the development of innovative models of care include the planning, development, implementation, evaluation and assessment of the sustainability of the new model. Regardless of whether change in health care delivery is attempted on a micro basis (eg. ward level) or macro basis (eg. national or state system) in order to achieve sustainable, effective and efficient changes a well-planned, systematic process is essential.

Delivery of Health Care↗