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Biomedical subjects

Tom Quinn

Publications and source records attributed to Tom Quinn.

16 recordsLinked to original sources
PubMed2006

Recovery after coronary artery bypass grafting: patients' and health professionals' views of the hospital experience.

BACKGROUND: Increasing access to revascularisation procedures is a key aspect of a National Service Framework. Coronary artery bypass grafting (CABG) is effective in relieving symptoms and reducing mortality but some patients do not report an improved quality of life or experience a good recovery. AIMS: To describe the recovery trajectory after CABG and identify facilitators and barriers to recovery. METHODS: Semi-structured interviews were conducted with 11 patients who had previously undergone elective, isolated, first-time CABG and with 10 health professionals experienced in caring for these patients. RESULTS: Thematic analysis identified the following themes: definition and timeline of recovery, preparation for surgery including information provision, attitude to surgery and confidence in staff, clinical factors and the in-patient experience. The key finding is the different recovery trajectory between patients with severe versus mild pre-operative symptoms; patients with few pre-CABG symptoms reported a much longer recovery time. CONCLUSIONS: This study has provided insights into the barriers and facilitators to recovery after CABG and the processes involved. Findings have indicated areas where health professionals can intervene to aid patients' long-term recovery and thereby maximise the benefits of CABG.

Aged↗
PubMed2006

Paramedics' perceptions of their role in providing pre-hospital thrombolytic treatment: qualitative study.

BACKGROUND: The majority of ambulance services in England provide pre-hospital thrombolysis, following publication of the National Service Framework for Coronary Heart Disease. A meta-analysis has confirmed the effectiveness of pre-hospital administration in terms of all-cause mortality reduction and time saved. Little is known however, about how paramedics perceive their role in thrombolytic administration. AIMS: To describe ambulance paramedics' perceptions of their role in delivering thrombolytic treatment in the pre-hospital setting. METHODS: Twenty paramedics, based in one rural ambulance service in the South West of England participated in focus group interviews. RESULTS: Five key themes emerged: Perceptions of drivers for change; duty of care; perceptions of professional image; role expansion; and preparedness for practice. CONCLUSION: Paramedics' perceptions of their role in pre-hospital thrombolysis were mixed, encompassing professional and political issues including lack of ownership of the emerging national strategy, desire for national certification and financial reward. For successful development and implementation of new strategies within the ambulance service early engagement of paramedics and other staff is essential.

Attitude of Health Personnel↗
PubMed2006

Acute coronary syndrome nurses: perceptions of other members of the health care team.

Acute coronary syndromes (ACS) are a major health care problem and result in a large number of hospital admissions each year. Nurses across the NHS are being empowered to undertake a growing range of responsibilities but little research evidence exists related to the impact on patient care nor working practice with other health professionals. This paper reports part of the evaluation of a British Heart Foundation pilot project to place an 'ACS nurse' in participating hospitals. In each of 5 hospitals, 100 staff across accident and emergency, general medicine and cardiac specialities were sent a questionnaire. The response rate was 33%. Respondents felt that the ACS nurse role was beneficial to patient care and had little overlap with existing roles within the hospital. Support for nurse initiated thrombolysis was high, but comments reflected the on-going debate around accountability and training. Communication and problem solving were identified as key elements of the ACS nurse role. Findings in this study show support for the integration of an ACS nurse role as a way to provide improved care to ACS patients.

Acute Disease↗
PubMed2005

Management of acute coronary syndromes, a questionnaire survey of the clinical practice of cardiologists and other medical physicians belonging to west midland hospitals.

OBJECTIVE: To assess the management of acute coronary syndromes by cardiologists and other medical physicians in a clinical setting. DESIGN: Questionnaire survey consisting of 10 hypothetical clinical scenarios and four possible therapeutic options for each scenario. SETTING: Consultants and specialist registrars in Cardiology (with or without access to interventional facilities) and consultant physicians belonging to various hospitals in the west midland region of United Kingdom. MAIN OUTCOME MEASURES: Respondents' ability to recognise high risk patients and their management of the hypothetical clinical cases. To establish any differences in management strategy between cardiologists and general physicians, and whether these differences, if any, relate to access to interventional cardiac facilities. RESULTS: Overall no significant differences were found in the responses between cardiologists and general physicians with or without access to cardiac interventional facilities. However, cardiologists were more inclined to use percutaneous transluminal coronary angioplasty (PTCA) compared to other physicians (scenario 8, 18.4% vs. 6.7%, p = 0.05 and scenario 9, 44.9% vs. 26.7%, p = 0.01). In two other situations, physicians from institutions with access to interventional facilities were more inclined to use 'other' treatment strategies (intravenous nitrates, antiplatelet treatment, inotropes, Intra-aortic balloon pump) compared to their colleagues from non-tertiary hospitals with no interventional facility on site (scenario 3, 21.7% vs. 2.4%, p = 0.04) and more use of PTCA ( scenario 6, 52.2% vs. 26.8%, p = 0.04). CONCLUSIONS: The management of acute coronary syndromes in this questionnaire survey was satisfactory and evidence based. No real differences were found between the management strategies adopted by cardiologists or non-cardiologists. Physicians working in centres with interventional facilities were no more inclined towards using primary PTCA or rescue angioplasty than those working in centres without such facilities.

Acute Disease↗
PubMed2004

Influences upon the diffusion of thrombolysis for acute myocardial infarction in England: case study.

OBJECTIVES: To investigate the factors that influenced the adoption and diffusion of thrombolysis in acute myocardial infarction in England and to verify usage data from 1981 to 2001. METHODS: Survey of cardiologists in England using a pre-prepared time line of historical events and a plot of thrombolysis diffusion since 1981. The cardiologists were divided into three groups that were provided with (i) the time line only, (ii) the diffusion curve only, and (iii) the time line and the diffusion curve. RESULTS: The GISSI and ISIS-2 clinical trials were perceived to have had a significant influence upon the initial diffusion of thrombolysis in England occurring over the 3 years after launch. Other positive influences included the initial listing in the national formulary, the change to administration in emergency departments, the rise in evidence-based medicine, and production of national guidance. CONCLUSIONS: Although it is apparent that the overall influences on adoption and diffusion of thrombolysis were multiple; clinical trials, service developments, and national guidelines all were judged to have played a part. The GISSI and ISIS-2 clinical trials were confirmed as the major influence on initial adoption.

Attitude of Health Personnel↗
PubMed2003

Impact of a region-wide approach to improving systems for heart attack care: the West Midlands thrombolysis project.

OBJECTIVE: To describe changes in delay to administration of thrombolytic therapy associated with a region-wide audit. DESIGN: Observational study of patients admitted with suspected myocardial infarction (MI) based on continuous audit. SUBJECTS: 18877 patients admitted to 23 hospitals with suspected MI between April 1995 and March 1998. RESULTS: Of 11232 patients with a discharge diagnosis of definite MI, 8802 (46.6%) received thrombolytic therapy during hospitalisation, with 5155 patients eligible for treatment on admission to hospital on the basis of established indications. Call-to-needle time for those eligible for treatment on admission fell from median 105 min in the first year of the project to 85 min in year 3 (P<0.001), and door-to-needle time fell from 45 to 35 min (P<0.001). Forty percent of eligible patients were treated within the then current national standard of 90 min from time of call for help, with nearly 49% in the final year and 20% being treated within the new national standard of 60 min, by the third year. CONCLUSION: The proportion of eligible patients receiving thrombolysis within 1 h of the call for help doubled during the 3-year project but the majority of patients still wait longer than 60-min 'call-to-needle'. New systems to reduce delays to administration of thrombolysis to within 60 min of call for help are required, including consideration of pre-hospital treatment.

Aged↗
PubMed2003

Patient care advisers: helping cardiac surgery patients to exercise choice.

Cardiac surgical centres have received funds to appoint at least one patient care adviser as part of the Government's Patient Choice Initiative. Mostly from a nursing background, their role is to ensure patients who have been waiting more than six months have the choice of receiving surgery sooner at another centre. This paper describes this national initiative.

Cardiovascular Surgical Procedures↗
PubMed2002

Effective nurse-led interventions in heart disease.

Nurses are increasingly being involved in initiatives to improve the co-ordination, delivery and eventual outcomes of health care. Key components of these initiatives include application of evidence-based treatments, ensuring individualised follow-up and the provision of "seamless" care overall. There is evidence in key areas that nurse-led interventions for patients with heart disease are effective, and that they are likely to work in other areas if properly supported and appropriate structures and systems are put in place to promote such practice. Given the promising results to date, it would be disappointing if these issues remain unresolved and the potential value of this type of interventions unfulfilled.

Heart Diseases↗
PubMed2002

Implementing paramedic thrombolysis--an overview.

The UK Government has made improvements in cardiac care a high priority. The publication in 2000 of the National Service Framework for Coronary Heart Disease and the NHS Plan set out national standards for the management of suspected heart attack, including challenging targets for reducing treatment delays for administration of thrombolytic therapy. This paper discusses the background, evidence base and challenges of implementing one component of the Government's drive to improve cardiac care: the NHS Plan commitment to a three year programme to equip and train ambulance paramedics to safely provide thrombolysis for appropriate patients.

Ambulances↗