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Biomedical subjects

Philip Darbyshire

Publications and source records attributed to Philip Darbyshire.

18 recordsLinked to original sources
PubMed2006

Engagement with health and social care services: perceptions of homeless young people with mental health problems.

The present qualitative study describes and discusses the perspectives and experiences of young homeless people with mental health problems in relation to their interactions with health and social care services. Working in partnership with Streetlink, a supported accommodation assistance programme in Adelaide, Australia, the authors interviewed 10 homeless young people, aged from 16 to 24 years of age, who had experienced mental health problems. In-depth interviews elicited accounts of the best and worst of the participants' experiences of health and social care services. Access to services was not identified as being a significant problem in comparison with the participants' concerns regarding the quality of the services encountered. The central findings stress the importance of a respectful and supportive climate in relation to the qualities of service provision that the young people identified as valuable for their continuing treatment or consultation.

Adolescent↗
PubMed2006

Children's and young people's experiences of chronic renal disease: a review of the literature, methodological commentary and an alternative proposal.

AIM: The aims of this paper were to review and critique existing research literature on children's and young people's experiences of chronic renal disease and to propose alternative approaches that may be more fruitful in addressing existing research shortcomings. BACKGROUND: Chronic renal disease, which results in approximately 1.6-4 new cases per year per million population in the 0-15 years age group, is a serious illness that causes severe and irreversible reduction in kidney function. Despite modern medical advances, its significance and implications for the lives of the children and young people concerned are profound. METHOD: Salient literature for this review was obtained using the major health and social science electronic databases such as Medline, CINAHL, Psyclit and Sociofile. Manual searching of relevant books, journals and 'grey literature', combined with the genealogy approach, extended and strengthened the search. CONCLUSIONS: Research in this area focuses mainly on two areas, namely psychological adjustment and adaptation to end-stage renal disease. This research is grounded within a framework of empirical psychology that values objectivity, measurement and quantification. This predominantly psychometric approach is critiqued for simplifying the complex experience of end-stage renal disease and for pathologizing children and young people with this disease. We identify a significant gap in the research literature, namely the lack of research that takes into account these children's and young peoples'own perspectives of their experiences. RELEVANCE TO CLINICAL PRACTICE: Chronic renal disease has a significant impact on children's and young people's lives. Understanding the experiences of these children is important for the provision of effective healthcare. Conducting child-centred qualitative research in this area would allow us to explore vital questions of meaning, perception and understanding. If health and social care organizations claim to provide 'consumer-focused' services, it behoves us to develop first a clearer understanding of the lives and experiences of children and families who seek our help and to use this knowledge and understanding to plan and provide more grounded and responsive services.

Adaptation, Psychological↗
PubMed2006

Self-management of medication for mental health problems by homeless young people.

Youth homelessness is a growing Australian and international concern associated with considerable health disadvantage, including serious mental health problems. This paper reports findings of a qualitative study that explored young homeless people's experiences of mental health and well-being through in-depth interviews. Thematic analysis identified medication use and management as a central issue for the young people. Reasons identified for medication non-adherence included unwanted side-effects, issues of access and storage, and lack of support from health and social agencies. These problems were compounded by everyday stresses of homelessness. Medication adherence was facilitated by social support, consistent contact with supportive health services, and regular medication supply, often resulting in improved mental health and well-being. For these young people, prioritizing management of medication helped stabilize one aspect of their lives. Health professionals can play an important role in helping them achieving this goal.

Adaptation, Psychological↗
PubMed2005

Donor KIR genotype has a major influence on the rate of cytomegalovirus reactivation following T-cell replete stem cell transplantation.

Reactivation of cytomegalovirus (CMV) is a common complication following allogeneic stem cell transplantation. Genetic determinants in the host and donor that may influence the rate of reactivation are currently unknown. Viral replication is controlled by T cells and natural killer (NK) cells and these share expression of killer immunoglobulin-like receptors (KIRs). We analyzed whether activatory KIRs carried by the donor influenced the subsequent rate of CMV reactivation in the patient. In transplantations involving siblings where both donor and recipient were CMV seropositive, donors with more than one activating KIR gene were associated with a 65% reduction in CMV reactivation. Multivariate analysis confirmed a significantly reduced risk of CMV reactivation in sibling transplantations where the donor had more than one activating KIR. Reduced-intensity transplantation and graft-versus-host disease grade 2 or higher were associated with an increased risk of CMV reactivation. This observation indicates that activating KIRs play an important role in the cellular control of CMV reactivation.

Adolescent↗
PubMed2005

Antenatal screening for Group B Streptococcus: a diagnostic cohort study.

BACKGROUND: A range of strategies have been adopted to prevent early onset Group B Streptococcal (EOGBS) sepsis, as a consequence of Group B Streptococcal (GBS) vertically acquired infection. This study was designed to provide a scientific basis for optimum timing and method of GBS screening in an Australian setting, to determine whether screening for GBS infection at 35-37 weeks gestation has better predictive values for colonisation at birth than screening at 31-33 weeks, to examine the test characteristics of a risk factor strategy and to determine the test characteristics of low vaginal swabs alone compared with a combination of perianal plus low vaginal swabs per colonisation during labour. METHODS: Consented women received vaginal and perianal swabs at 31-33 weeks gestation, 35-38 weeks gestation and during labour. Swabs were cultured on layered horse blood agar and inoculated into selective broth prior to analysis. Test characteristics were calculated with exact confidence intervals for a high risk strategy and for antenatal screening at 31-33 and 35-37 weeks gestation for vaginal cultures alone, perianal cultures alone and combined low vaginal and perianal cultures. RESULTS: The high risk strategy was not informative in predicting GBS status during labour. There is an unequivocal benefit for the identification of women colonised with GBS during labour associated with delaying screening until 36 weeks however the results for method of screening were less definitive with no clear advantage in using a combined low vaginal and perianal swabbing regimen over the use of a low vaginal swab alone. CONCLUSION: This study can contribute to the development of prevention strategies in that it provides clear evidence for optimal timing of swabs. The addition of a perianal swab does not confer clear benefit. The quantification of advantages and disadvantages provided in this study will facilitate communication with clinicians and pregnant women alike.

Journal Article↗
PubMed2005

Moving from institutional dependence to entrepreneurialism. Creating and funding a collaborative research and practice development position.

AIMS OF THE PAPER: The paper describes the creation of, the rationale behind and the external funding of a collaborative research-clinical practice development position. The paper also demonstrates the benefits of nursing's collaboration with external funding bodies and the value of moving from our traditional position of assuming that 'the hospital' will always provide. BACKGROUND: There is a constant refrain that nursing must become more 'research-based' and develop an active research culture. In harsh financial times however, funding for research development is scarce. Nurses can respond to this by bemoaning the lack of money or by taking an entrepreneurial approach, creating innovative project proposals that develop new partnerships and attract external funding. DISCUSSION: Institutional support for clinical research is often more verbal than financial as most health care systems are experiencing extreme financial stringencies. Nurses need to reconsider the notion that every initiative must automatically be funded by the institution. In this paper we show how in a busy major hospital, clinicians and researchers collaborated to create and fund the kind of innovative research and practice development position that may be impossible to fund through existing budgets. CONCLUSION: With creativity and determination, nurses can challenge the orthodoxy that they are solely dependent on institutional funding. If there is a clear project vision, a convincing rationale, a strongly argued 'business case' and a passionate and persistent team, then innovative new projects and positions can be realized. RELEVANCE TO CLINICAL PRACTICE: Developing clinical focused, practice based research is now a worldwide policy and practice imperative for nurses. Unfortunately, current levels of institutional funding are unlikely to support research promotion positions and initiatives. This paper outlines an approach to securing funding for research initiatives that can create exciting new positions and develop productive partnerships between researchers, clinicians and external agencies.

Clinical Nursing Research↗
PubMed2005

Land mines in the field: a modest proposal for improving the craft of qualitative health research.

In this commentary, the authors encourage a renewed enthusiasm for attention to quality criteria in qualitative health research by poking fun at what they understand to be patterns and themes emerging from data collected in their respective extensive "fieldwork" experiences within the genre. Conceptualizing some of the particularly problematic interpretive turns as land mines in the field (or, alternatively, missteps in the dance, cracks in the pottery, wrong turns in the journey, weeds in the garden, or dropped stitches in the quilt), they challenge researchers' collective relationship to both factual and metaphoric empirical claims. With a warning to those unaccustomed to self-deprecating humor, the authors challenge all to pay serious heed to what does and does not constitute rigorous, high-quality, empirical science within the qualitative tradition.

Australia↗
PubMed2005

Culture, communication and child health.

Cultural beliefs and values implicitly and explicitly shape every aspect of the way we parent our children and how we communicate about parenting. To appropriately support parents in this new and challenging role, child health services for parents in Australia need to do more than acknowledge a diverse range of cultural practices. While many health professionals believe they act in culturally sensitive ways, we need to closely examine this belief, question the cultural assumptions implicit in the information we give, and assess the extent to which our interactions are culturally appropriate. In this paper, we present a critical review of the literature on health care provision for migrant women and families. We then suggest a need to re-examine the values, beliefs and attitudes within cultural frameworks that inform how child health professionals communicate. Specifically, communication between child health professionals and migrant parents requires further analysis. We suggest that professionals need to reflect on the cultural self rather than solely on the culture of others.

Child↗
PubMed2004

'Rage against the machine?': nurses' and midwives' experiences of using Computerized Patient Information Systems for clinical information.

BACKGROUND: Computerized Patient Information Systems (CPIS) are used increasingly in health care, yet few studies have asked clinicians to describe their experiences of using these systems and what they mean to their practice and patient care. AIMS AND OBJECTIVES: The aim of this study was to explore clinical nurses' and midwives' perceptions and understandings of computerized information systems in everyday practice. The objective was to provide a detailed and faithful account of clinicians' experiences of using such systems. DESIGN: A qualitative design was used, based upon interpretive phenomenology. METHODS: A total of 13 focus groups involving 53 practitioners was conducted in hospitals across five Australian states with nurses and midwives from a wide range of practice settings. The participants ranged from Level 1 RNs to Clinical Nurse Consultants and nurses with an IT project management role. RESULTS: This study focuses specifically on clinicians' experiences of using CPIS to manage clinical information. Clinicians' experiences were characterized by digital disappointment rather than electronic efficiencies. Clinicians reported generally that computerization had neither enhanced their clinical practice nor patient care, nor had it improved patient outcomes. CONCLUSIONS: Participants' experiences were predominantly negative and mostly critical of CPIS and their: perceived inability to capture 'real nursing', difficulty in use, incompatibilities, non-responsiveness and irrelevance to patient care and meaningful clinical outcomes. RELEVANCE TO CLINICAL PRACTICE: Technological 'solutions' to health care problems are endlessly seductive and easily entrance policy and decision makers. Computerization will continue to impact upon clinical practice and cannot be wished away. Today's computerized systems may have been developed with scant regard for clinician end-users. A crucial issue facing everyone in health informatics is how point-of-care systems can be developed in ways that involve clinicians meaningfully and which recognize and respond to the complexity and subtlety of the world of nursing and midwifery practice.

Attitude of Health Personnel↗
PubMed2003

Taking antenatal group B Streptococcus seriously: women's experiences of screening and perceptions of risk.

BACKGROUND: Early-onset group B streptococcal disease is a serious cause of neonatal morbidity and mortality. Although screening protocols for group B streptococcus are common, little is known of women's perceptions of this screening and the disease itself. The purpose of this study was to gain an understanding of women's experiences, knowledge, and perceptions about this bacteria and its screening. METHODS: Nine focus group interviews with 35 women explored their experiences and understanding of group B streptococcus screening. Transcribed interview data were interpreted to identify and articulate the women's experiences. RESULTS: Most women had little knowledge or understanding of group B streptococcus, obtaining their information largely from the stories or experiences of friends or family. Women struggled to understand the meaning and implications, both physical and "moral," of the disease for their baby and for themselves, clearly indicating both the subjective and statistical importance of the concept of risk for pregnant women. CONCLUSIONS: Group B streptococcus continues to be poorly understood by pregnant women who try to understand and weigh up its risks and implications so as to make the best decisions about screening. The women participated in screening ultimately, however, since it was seen to be patently "best for baby," relatively easy for them to undergo, and part of routine antenatal care.

Adult↗
PubMed2003

Mothers' experiences of their child's recovery in hospital and at home: a qualitative investigation.

Decreasing hospital stays, increasing day surgery and the assumption that parents will manage their child at home necessitate research into children's recovery. Given the scarcity of studies seeking parents' perspectives, this exploratory and interpretive study is timely, presenting a detailed account of mothers' experiences of managing their child's recovery in hospital and at home. The study supports the view that recovery begins not with discharge, but with admission and before, as hospital experiences directly shape the recovery process. Mothers' experiences of hospital's recovery enablers and inhibitors suggest that good recovery practices and policies remain erratic. Following discharge, parents help the child 'back to normal' by 'reading the recovering child' and balancing the child's desire for activity with the need for caution and safety. Developing a deeper understanding of parents' recovery experiences and perceptions would help nurses to form an empathic 'grounding' upon which to base improvements in children's recovery care.

Adaptation, Psychological↗
PubMedDate not supplied

CD3+CD4-CD8+NK- large granular lymphocytosis with neutropenia and evidence for clonality and T-cell receptor gene rearrangement: two pediatric cases.

The authors describe two pediatric cases of large granular lymphocytosis presenting early in the second decade of life with neutropenia and sepsis. They are among the youngest described in the literature. This report focuses on the advantages of detailed immunophenotypic and molecular analysis and highlights some of the controversies and uncertainties in the management of these patients, particularly the choice of immunosuppressive therapy. Immunosuppressive therapy in the two children described in this report resulted in improvement of neutropenia and clinical status, but this was not accompanied by the disappearance of the clonal population.

CD3 Complex↗
PubMedDate not supplied

'Sometimes they run away, that's how scared they feel': the peadiatric hospitalisation experiences of Indigenous families from remote areas of Australia.

Hospitalisation can be a traumatic experience for any child and family but the experience can be significantly more so for Indigenous parents and children from remote areas of Australia. Despite the importance of this issue for child and family health and for Indigenous health, the hospitalisation experiences of Indigenous families and children have received almost no research attention. This paper describes selected findings from a recently completed Honours research study which used the participatory and collaborative Indigenous research approach of Dadirri to explore this question. Following a brief description of the methodology of Dadirri, the paper presents the participating families' depictions of their experiences of 'Coming Down' and 'Being in Hospital', where they revealed the extent and effects of marked culture shock. The significant cultural differences between staff and Indigenous families contributed to the parents' sense of fear, powerlessness and isolation from their child, home community and culture. For these families this isolation was not merely geographic but intricately linked to their health and wellbeing.

Adaptation, Psychological↗
PubMedDate not supplied

'I know my body, I've lived in it all my life': therapy experiences of young people with disabilities.

Remedial surgery and other treatments are a common feature of disabled childhoods. These treatments are founded on notions of a normal:abnormal divide in which the task of health professionals is to bring such young people as close to societal concepts of normal as possible. Working with new paradigm disability and childhood research young people who are growing up with a disability have been able to contribute to our understanding from their perspectives. The young people identify the physical, social and emotional implications of remediation and identify a personal cost:benefit ratio. Questions of outcomes, definitions of success, and 'how much remediation is enough?' further complicate this. What may be perceived as a successful outcome by the health professional may not result in any functional gain for the young person. In discourses heavily influenced by health professional and parent perceptions the inclusion of the young people themselves contributes an additional dimension to our understanding.

Activities of Daily Living↗