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Graham J, Mayne A, Craig J, Spence D. Patients undergoing hip hemiarthroplasty who require early return to theatre have early increased mortality and worse functional outcomes at short term follow-up. Injury 2023; 54:110946. [PMID: 37517375 DOI: 10.1016/j.injury.2023.110946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/08/2023] [Accepted: 07/15/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Re-operation following hip hemiarthroplasty is potentially devastating due to a frail, co-morbid surgical cohort. We aimed to assess the outcomes of patients who required early return to theatre (RTT) within 30 days of index operation in a high-volume hip fracture unit. METHODS A retrospective review of a prospectively maintained database was undertaken. All hip hemiarthroplasties performed between 1st January 2010 and 31st December 2019 was included. Demographic details, complications including reason for return to theatre, length of stay, discharge destination, functional outcome and mortality were collected and reviewed. RESULTS 4340 hip hemiarthroplasty procedures were performed, of which 64 patients (1.47%) required early RTT within 30 days of index procedure and 4276 patients did not require early-RTT. The most common reasons for RTT were infection (n = 47) and dislocation (n = 15). There were no cases of peri‑prosthetic fracture requiring RTT within 30 days. Patients requiring early RTT had a significantly increased rate of mortality within 120 days; 32.8% (21 of the 64 patients) versus 13.6% (580 out of the 4276) not requiring early RTT (p < 0.001). The median length of acute inpatient admission for patients who required early RTT was significantly longer at 31 days (range 6-185 days) compared to 10 days (range 3-171 days, p < 0.001) for those without early RTT. Early RTT was associated with a poorer functional mobility outcome at 120 days post-operatively, with a significantly greater reduction in Barthel score compared to the non-RTT cohort (p < 0.05). CONCLUSION Patients requiring early RTT following hip hemiarthroplasty had a significantly increased length of stay, mortality and worse functional outcome compared to patients who did not require early RTT within 30 days.
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Affiliation(s)
- J Graham
- Royal Victoria Hospital, Belfast Health & Social Care Trust, Northern Ireland.
| | - A Mayne
- Royal Victoria Hospital, Belfast Health & Social Care Trust, Northern Ireland
| | - J Craig
- Royal Victoria Hospital, Belfast Health & Social Care Trust, Northern Ireland
| | - D Spence
- Royal Victoria Hospital, Belfast Health & Social Care Trust, Northern Ireland
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Jacobs M, Geiger M, Summers S, Janes T, Boyea R, Zinn K, Aburashed R, Spence D. Interferon-β Decreases the Hypermetabolic State of Red Blood Cells from Patients with Multiple Sclerosis. ACS Chem Neurosci 2022; 13:2658-2665. [PMID: 35946788 DOI: 10.1021/acschemneuro.2c00332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Multiple sclerosis (MS) is an inflammatory disease characterized by damage to the myelin sheath surrounding axons in the central nervous system. While the exact mechanism of this destruction is unknown, excess nitric oxide (NO) and adenosine triphosphate (ATP) have been measured in tissues and fluids obtained from people with MS. Here, incubation of interferon-beta (IFN-β), an MS drug with an unknown mechanism of action, with red blood cells (RBCs) obtained from people with MS provide evidence of a potential hypermetabolic state in the MS RBC that is decreased with IFN-β intervention. Specifically, binding of all three components of an albumin/C-peptide/Zn2+ complex to MS RBCs was significantly increased in comparison to control RBCs. For example, the binding of C-peptide to MS RBCs was significantly increased (3.4 ± 0.1 nM) compared to control RBCs (1.6 ± 0.2 nM). However, C-peptide binding to MS RBCs was reduced to a value (1.6 ± 0.3 nM) statistically equal to that of control RBCs in the presence of 2 nM IFN-β. Similar trends were measured for albumin and Zn2+ binding to RBCs when in the presence of IFN-β. RBC function was also affected by incubation of cells with IFN-β. Specifically, RBC-derived ATP and measurable membrane GLUT1 were both significantly decreased (56 and 24%, respectively) in the presence of IFN-β. Collectively, our results suggest that IFN-β inhibits albumin binding to the RBC, thereby reducing its ability to deliver ligands such as C-peptide and Zn2+ to the cell and normalizing the basal hypermetabolic state.
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Affiliation(s)
- M Jacobs
- Department of Comparative Medicine and Integrative Biology, Michigan State University, East Lansing, Michigan 48824, United States.,Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, Michigan 48824, United States
| | - M Geiger
- Department of Chemistry, Michigan State University, East Lansing, Michigan 48824, United States.,Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, Michigan 48824, United States
| | - S Summers
- Department of Biomedical Engineering, Michigan State University, East Lansing, Michigan 48824, United States.,Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, Michigan 48824, United States
| | - T Janes
- Department of Chemistry, Michigan State University, East Lansing, Michigan 48824, United States
| | - R Boyea
- Department of Chemistry, Michigan State University, East Lansing, Michigan 48824, United States
| | - K Zinn
- Department of Biomedical Engineering, Michigan State University, East Lansing, Michigan 48824, United States.,Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, Michigan 48824, United States
| | - R Aburashed
- Memorial Healthcare Institute for Neuroscience, Michigan State University, East Lansing, Michigan 48824, United States
| | - D Spence
- Department of Biomedical Engineering, Michigan State University, East Lansing, Michigan 48824, United States.,Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, Michigan 48824, United States
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Geiger M, Hayter E, Martin R, Spence D. Red blood cells in type 1 diabetes and multiple sclerosis and technologies to measure their emerging roles. J Transl Autoimmun 2022; 5:100161. [PMID: 36039310 PMCID: PMC9418496 DOI: 10.1016/j.jtauto.2022.100161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/14/2022] [Accepted: 07/21/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- M. Geiger
- Institute of Quantitative Health Sciences and Engineering, Michigan State University, East Lansing, MI 48824, USA
- Department of Biomedical Engineering, Michigan State University, East Lansing, MI 48824, USA
| | - E. Hayter
- Department of Chemistry, Saint Louis University, St. Louis, MO 63103, USA
| | - R.S. Martin
- Department of Chemistry, Saint Louis University, St. Louis, MO 63103, USA
| | - D. Spence
- Institute of Quantitative Health Sciences and Engineering, Michigan State University, East Lansing, MI 48824, USA
- Department of Biomedical Engineering, Michigan State University, East Lansing, MI 48824, USA
- Corresponding author. 775 Woodlot Drive, East Lansing, MI 48824, USA.
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Smythe E, Spence D. Heideggerian phenomenological hermeneutics: Working with the data. Nurs Philos 2020; 21:e12308. [PMID: 32583566 DOI: 10.1111/nup.12308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/23/2020] [Accepted: 05/26/2020] [Indexed: 11/30/2022]
Abstract
It is one thing to read about the methodology and methods of Heideggerian hermeneutic phenomenological research, the ontic description. It is quite another thing to be faced with an interview transcript. This article draws on a study that asked doctoral students about their experience of doing such research. How did they become "phenomenological/hermeneutic" in their thinking and writing? What helped them to find their way? We offer this article as a means of letting others learn from our own experiences. We support our insights with the writings of Heidegger and Gadamer to show the methodological congruence that is essential to Heideggerian phenomenological hermeneutic research.
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Affiliation(s)
- Elizabeth Smythe
- Faculty of Health and Environment Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Deb Spence
- Faculty of Health and Environment Sciences, Auckland University of Technology, Auckland, New Zealand
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5
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Smythe E, Spence D. Reading Heidegger. Nurs Philos 2019; 21:e12271. [PMID: 31314178 DOI: 10.1111/nup.12271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/31/2019] [Accepted: 06/03/2019] [Indexed: 11/28/2022]
Abstract
Heidegger's philosophy is a significant contribution to understanding the meaning of lived experience. Recognizing this, nurses and other health professionals have taken on the research approach of Heideggerian hermeneutic phenomenology. This requires reading the writing of Heidegger. Philosophers themselves acknowledge this writing is dense, difficult to grasp, uses language for which there is no easy translation, and leaves the reader with more questions than answers. Drawing on commentary from philosophers who seek to read Heidegger and from a research study which interviewed doctoral students who were "reading Heidegger," we seek to show the nature of the experience of pursuing such a challenging quest.
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Affiliation(s)
- Elizabeth Smythe
- Faculty of Health and Environment Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Deb Spence
- Faculty of Health and Environment Sciences, Auckland University of Technology, Auckland, New Zealand
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Vija AH, Bartenstein PA, Froelich JW, Kuwert T, Macapinlac H, Daignault CP, Gowda N, Hadjiev O, Hephzibah J, Huang P, Ilhan H, Jessop A, Cachovan M, Ma J, Ding X, Spence D, Platsch G, Szabo Z. ROC study and SUV threshold using quantitative multi-modal SPECT for bone imaging. Eur J Hybrid Imaging 2019; 3:10. [PMID: 34191147 PMCID: PMC8218047 DOI: 10.1186/s41824-019-0057-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/24/2019] [Indexed: 11/23/2022] Open
Abstract
Background We investigated the clinical performance of a quantitative multi-modal SPECT/CT reconstruction platform for yielding radioactivity concentrations of bone imaging with 99mTc-methylene diphosphonate (MDP) or 99mTc-dicarboxypropane diphosphonate (DPD). The novel reconstruction incorporates CT-derived tissue information while preserving the delineation of tissue boundaries. We assessed image-based reader concordance and confidence, and determined lesion classification and SUV thresholds from ROC analysis. Methods Seventy-two cancer patients were scanned at three US and two German clinical sites, each contributing two experienced board-certified nuclear medicine physicians as readers. We compared four variants of the reconstructed data resulting from the Flash3D (F3D) and the xSPECT Bone™ (xB) iterative reconstruction methods and presented images to the readers with and without a fused CT, resulting in four combinations. We used an all-or-none approach for inclusion, compiling results only when a reader completed all reads in a subset. After the final read, we conducted a “surrogate truth” reading, presenting all data to each reader. For any remaining discordant lesions, we conducted a consensus read. We next undertook ROC analysis to determine SUV thresholds for differentiating benign and lesional uptake. Results On a five-point rating scale of image quality, xB was deemed better by almost two points in resolution and one point better in overall acceptance compared to F3D. The absolute agreement of the rendered decision between the nine readers was significantly higher with CT information either inside the reconstruction (xB, xBCT) or simply through image fusion (F3DCT): 0.70 (xBCT), 0.67 (F3DCT), 0.64 (xB), and 0.46 (F3D). The confidence level to characterize the lesion was significantly higher (3.03x w/o CT, 1.32x w/CT) for xB than for F3D. There was high correlation between xB and F3D scores for lesion detection and classification, but lesion detection confidence was 41% higher w/o CT, and 21% higher w/CT for xB compared to F3D. Without CT, xB had 6.6% higher sensitivity, 7.1% higher specificity, and 6.9% greater AUC compared to F3D, and similarly with CT-fusion. The overall SUV-criterion (SUVc) of xB (12) exceeded that for xSPECT Quant™ (xQ; 9), an approach not using the tissue delineation of xB. SUV critical numbers depended on lesion volume and location. For non-joint lesions > 6 ml, the AUC for xQ and xB was 94%, with SUVc > 9.28 (xQ) or > 9.68 (xB); for non-joint lesions ≤ 6 ml, AUCs were 81% (xQ) and 88% (xB), and SUVc > 8.2 (xQ) or > 9.1 (xB). For joint lesions, the AUC was 80% (xQ) and 83% (xB), with SUVc > 8.61 (xQ) or > 13.4 (xB). Conclusion The incorporation of high-resolution CT-based tissue delineation in SPECT reconstruction (xSPECT Bone) provides better resolution and detects smaller lesions (6 ml), and the CT component facilitates lesion characterization. Our approach increases confidence, concordance, and accuracy for readers with a wide range of experience. The xB method retained high reading accuracy, despite the unfamiliar image presentation, having greatest impact for smaller lesions, and better localization of foci relative to bone anatomy. The quantitative assessment yielded an SUV-threshold for sensitively distinguishing benign and malignant lesions. Ongoing efforts shall establish clinically usable protocols and SUV thresholds for decision-making based on quantitative SPECT.
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Affiliation(s)
- A H Vija
- Molecular Imaging, Siemens Medical Solutions USA, Inc, Hoffman Estates, IL, USA.
| | | | | | - T Kuwert
- Friedrich Alexander Universität Erlangen, Erlangen, Germany
| | | | - C P Daignault
- University of Minnesota, Minneapolis, MN, USA.,Veterans Medical Center, Minneapolis, MN, USA
| | - N Gowda
- University of Minnesota, Minneapolis, MN, USA.,Consulting Radiology, Edina, MN, USA
| | - O Hadjiev
- University of Minnesota, Minneapolis, MN, USA.,Milwaukee Radiologists, Greenfield, WI, USA
| | - J Hephzibah
- Johns Hopkins University, Baltimore, MD, USA.,Christian Medical College, Vellore, India
| | - P Huang
- Johns Hopkins University, Baltimore, MD, USA
| | - H Ilhan
- Ludwig-Maximilians Universität, München, Munich, Germany
| | - A Jessop
- MD Anderson Cancer Center, Houston, TX, USA.,Vanderbilt University Medical Center, Nashville, TN, USA
| | - M Cachovan
- Siemens Healthineers GmbH, Erlangen, Germany
| | - J Ma
- Molecular Imaging, Siemens Medical Solutions USA, Inc, Hoffman Estates, IL, USA
| | - X Ding
- Molecular Imaging, Siemens Medical Solutions USA, Inc, Hoffman Estates, IL, USA
| | - D Spence
- Molecular Imaging, Siemens Medical Solutions USA, Inc, Hoffman Estates, IL, USA
| | - G Platsch
- Siemens Healthineers GmbH, Erlangen, Germany
| | - Z Szabo
- Johns Hopkins University, Baltimore, MD, USA
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Cardoso F, Senkus E, Costa A, Papadopoulos E, Aapro M, André F, Harbeck N, Aguilar Lopez B, Barrios CH, Bergh J, Biganzoli L, Boers-Doets CB, Cardoso MJ, Carey LA, Cortés J, Curigliano G, Diéras V, El Saghir NS, Eniu A, Fallowfield L, Francis PA, Gelmon K, Johnston SRD, Kaufman B, Koppikar S, Krop IE, Mayer M, Nakigudde G, Offersen BV, Ohno S, Pagani O, Paluch-Shimon S, Penault-Llorca F, Prat A, Rugo HS, Sledge GW, Spence D, Thomssen C, Vorobiof DA, Xu B, Norton L, Winer EP. 4th ESO-ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC 4)†. Ann Oncol 2018; 29:1634-1657. [PMID: 30032243 PMCID: PMC7360146 DOI: 10.1093/annonc/mdy192] [Citation(s) in RCA: 761] [Impact Index Per Article: 126.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- F Cardoso
- European School of Oncology (ESO), European Society for Medical Oncology (ESMO) and Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal.
| | - E Senkus
- European Society for Medical Oncology (ESMO) and Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - A Costa
- European School of Oncology, Milan, Italy
| | | | - M Aapro
- Oncology Department, Clinique de Genolier, Genolier, Switzerland
| | - F André
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - N Harbeck
- Breast Centre, Department of Obstetrics and Gynaecology, University of Munich (LMU), Munich, Germany
| | - B Aguilar Lopez
- Direction Office, ULACCAM (Union Latinoamericana Contra el Cáncer de la Mujer), Mexico DF, Mexico
| | - C H Barrios
- Department of Oncology, PURCS School of Medicine, Porto Alegre, Brazil
| | - J Bergh
- Department of Oncology-Pathology, Karolinska Institute & University Hospital, Stockholm, Sweden
| | - L Biganzoli
- European Society of Breast Cancer Specialists (EUSOMA) and Department of Medical Oncology, Nuovo Ospedale di Prato - Istituto Toscano Tumori, Prato, Italy
| | | | - M J Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation and Nova Medical School, Lisbon, Portugal
| | - L A Carey
- Department of Hematology and Oncology, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, USA
| | - J Cortés
- Department of Oncology, Vall d' Hebron University, Barcelona, Spain
| | - G Curigliano
- Division of Early Drug Development, Department of Oncology and Hemato-Oncology, European Institute of Oncology, University of Milano, Milano, Italy
| | - V Diéras
- Gynaecology and Breast Department, Centre Eugène Marquis, Rennes, France
| | - N S El Saghir
- Breast Center of Excellence, American University of Beirut Medical Center, Beirut, Lebanon
| | - A Eniu
- Breast Cancer Department, Cancer Institute Ion Chiricuta, Cluj-Napoca, Romania
| | - L Fallowfield
- SHORE-C, Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - P A Francis
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - K Gelmon
- Medical Oncology Department, BC Cancer Agency, Vancouver, Canada
| | | | - B Kaufman
- Department of Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - S Koppikar
- Department of Medical Oncology, Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - I E Krop
- Breast Oncology Center Dana-Farber Cancer Institute, Boston, USA
| | - M Mayer
- Advanced BC.org, New York, USA
| | - G Nakigudde
- Advocacy Department, UWOCASO (Uganda Women's Cancer Support Organization), Kampala, Uganda
| | - B V Offersen
- European Society of Radiation Oncology (ESTRO) and Department of Experimental Clinical Oncology & Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - S Ohno
- Cancer Institute Hospital, Breast Oncology Centre, Tokyo, Japan
| | - O Pagani
- Institute of Oncology of Southern Switzerland, Geneva University Hospitals, Swiss Group for Clinical Cancer Research (SAKK), International Breast Cancer Study Group (IBCSG), Bellinzona, Switzerland
| | - S Paluch-Shimon
- Oncology Institute, Shaare Zedek Medical Centre, Jerusalem, Israel
| | - F Penault-Llorca
- Department of Pathology, Centre Jean Perrin, Clermont-Ferrand Cedex, France
| | - A Prat
- IDIBAPS (Institut d'Investigacions Biomèdiques August Pi iSunyer), Hospital Clínic of Barcelona, Translational Genomics and Targeted Therapeutics in Solid Tumor, Barcelona, Spain
| | - H S Rugo
- Breast Oncology Clinical Trials Education, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, USA
| | - G W Sledge
- Oncology Division, Stanford University Medical Center, Stanford, USA
| | - D Spence
- Policy Department, Breast Cancer Network Australia, Camberwell, VIC, Australia
| | - C Thomssen
- Department of Gynaecology, Martin Luther University Halle-Wittenburg, Halle, Germany
| | - D A Vorobiof
- Oncology Department, Sandton Oncology Centre, Johannesburg, South Africa
| | - B Xu
- Department of Medical Oncology, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - L Norton
- Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York
| | - E P Winer
- Dana-Farber Cancer Institute, Susan Smith Center for Women's Cancers, Breast Oncology Center, Boston, USA
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Abstract
Hermeneutic phenomenology, as a methodology, is not fixed. Inherent in its enactment are contested areas of practice such as how interview data are used and reported. Using philosophical notions drawn from hermeneutic phenomenological literature, we argue that working with crafted stories is congruent with the philosophical underpinnings of this methodology. We consider how the practical ontic undertaking of story crafting from verbatim transcripts is integral with the interpretive process. We show how verbatim transcripts can be crafted into stories through examples taken from interview data. Our aim is to open dialogue with other hermeneutic phenomenological researchers and offer alternate possibilities to conventional ways of work with qualitative data. We argue that crafted stories can provide glimpses of phenomena that other forms of data analysis and presentation may leave hidden. We contend that crafted stories are an acceptable and trustworthy methodological device.
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Affiliation(s)
| | - Pam Ironside
- 2 Indiana University, Indianapolis, Indiana, USA
| | - Deb Spence
- 3 Auckland University of Technology, Auckland, New Zealand
| | - Liz Smythe
- 3 Auckland University of Technology, Auckland, New Zealand
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Affiliation(s)
- Tineke Water
- Department of Nursing, Auckland University of Technology, Auckland, New Zealand
| | - Katrina Ford
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Deb Spence
- Department of Nursing, Auckland University of Technology, Auckland, New Zealand
| | - Shayne Rasmussen
- Department of Nursing, Auckland University of Technology, Auckland, New Zealand
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Crowther S, Smythe E, Spence D. Kairos time at the moment of birth. Midwifery 2015; 31:451-7. [DOI: 10.1016/j.midw.2014.11.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 11/01/2014] [Accepted: 11/03/2014] [Indexed: 11/28/2022]
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Abstract
Nursing a person from another culture is a dynamic, complex and tension-filled phenomenon. It is also always culturally and historically situated. This paper provides an overview of the evolving meaning of 'culture' in New Zealand nursing. Then, drawing upon the findings of research that used hermeneutic phenomenology to explore the experience of nursing people from cultures other than one's own, a description of the constituent parts is of this phenomenon is briefly outlined and followed by an exemplar that describes the coalescent and contradictory nature of the phenomenon as a whole. As New Zealand nurses negotiate the conflicts essential for ongoing development of their practice, interplay of the notions of prejudice, paradox and possibility is evident at intrapersonal and interpersonal levels as well as in relation to professional and other discourses.
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Affiliation(s)
- Deb Spence
- School of Nursing and Midwifery, Auckland University of Technology, Auckland, New Zealand
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12
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Abstract
BACKGROUND Surgical nursing within humanitarian contexts is complex, sporadically described in literature and little understood. AIM To achieve a deeper understanding of the lived experience of New Zealand nurses providing humanitarian aid within surgical settings and war zones in developing countries. METHOD In-depth conversational interviews were undertaken with four New Zealand nurses whose humanitarian experience lay in general surgical, military, and intensive care settings. A qualitative descriptive method as described by Sandelowski, informed by van Manen's phenomenology in terms of analysis, was used. RESULTS Specialized knowledge and nursing expertise are recognized to be essential but not sufficient for humanitarian work. Understanding local cultures contributes to positive feelings about work effectiveness. Themes included feeling anxious and misunderstood, practicing differently, and adjusting to life back home. DISCUSSION This study highlights the need to better prepare nurses who volunteer for humanitarian work, with implications for recruiting organizations, educators, and clinicians.
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Affiliation(s)
- Shane Lal
- Auckland University of Technology, Auckland, New Zealand
| | - Deb Spence
- Auckland University of Technology, Auckland, New Zealand
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13
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Crowther S, Smythe E, Spence D. The joy at birth: An interpretive hermeneutic literature review. Midwifery 2014; 30:e157-65. [DOI: 10.1016/j.midw.2014.01.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 11/18/2013] [Accepted: 01/19/2014] [Indexed: 11/16/2022]
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15
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Scott-Pillai R, Spence D, Cardwell CR, Hunter A, Holmes VA. The impact of body mass index on maternal and neonatal outcomes: a retrospective study in a UK obstetric population, 2004-2011. BJOG 2013; 120:932-9. [DOI: 10.1111/1471-0528.12193] [Citation(s) in RCA: 200] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2013] [Indexed: 11/27/2022]
Affiliation(s)
- R Scott-Pillai
- School of Nursing and Midwifery; Queen's University; Belfast; UK
| | - D Spence
- School of Nursing and Midwifery; Queen's University; Belfast; UK
| | - CR Cardwell
- Centre for Public Health; School of Medicine; Dentistry and Biomedical Sciences; Queen's University; Belfast; UK
| | - A Hunter
- Royal Jubilee Maternity Service; Belfast Health and Social Care Trust; Belfast; UK
| | - VA Holmes
- Centre for Public Health; School of Medicine; Dentistry and Biomedical Sciences; Queen's University; Belfast; UK
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Abstract
Objective To undertake a systematic inquiry into the experience of living with dementia in the community. Design Action research, underpinned by critical hermeneutics, brought together action and reflection, theory and practice to generate knowledge. Data were gathered by interviews and observations in participants’ homes, and focus group discussions in community settings. Participants Eleven people with mild to moderate dementia and their primary caregiver aged 59–84, living in Auckland, New Zealand. Results The findings reveal a conflict between living positively with dementia, and enduring the negative attitudes that typify the dominant social discourse. The central argument arising from the findings is the significance of personal attitudes. Conclusions Implications for policy makers, health care providers, and caregivers highlight the need to change the ways in which dementia is perceived. The pursuit of positive attitudes will do much to change social perceptions and enable people with dementia to live with a sense of well-being.
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Affiliation(s)
| | | | - Deb Spence
- Auckland University of Technology, New Zealand
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17
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Spence D. Universal parenting classes won't help conduct disorders. Assoc Med J 2012. [DOI: 10.1136/bmj.e7977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Spence D. Bad medicine: thyroid disease. Assoc Med J 2012. [DOI: 10.1136/bmj.e7596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Spence D. Bad medicine: private practice. Assoc Med J 2012. [DOI: 10.1136/bmj.e5503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Napier RJ, Spence D, Diamond O, O'Brien S, Walsh T, Beverland DE. Modifiable factors delaying early discharge following primary joint arthroplasty. Eur J Orthop Surg Traumatol 2012; 23:665-9. [PMID: 23412186 DOI: 10.1007/s00590-012-1053-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 07/02/2012] [Indexed: 01/01/2023]
Abstract
AIMS Recent NHS reforms have incentivised reduction in length of stay, with the UK department of health expecting health trusts to reduce bed days and ultimately reduce overall costs. The aim of this study was to identify avoidable causes for protracted hospital admission following total hip arthroplasty (THA) or total knee arthroplasty (TKA) within a fast-track unit. METHODS During a 6-month period, 535 consecutive patients underwent primary THA or TKA under the care of a single surgeon. All patients with a post-operative stay of greater than 72 h were identified, and reasons for delayed discharge were determined. RESULTS The majority of arthroplasty patients were discharged within 3 days post-operatively. Twenty-one per cent of THA patients and 25 % of TKA patients remained as inpatients for greater than 72 h. For the THA population, this equates to 43 % of bed days used by 21 % of patients, and for the TKA population, 44 % of bed days were used by 25 % of patients. The major factor within both groups for delayed discharge was attributed to inadequate social support. CONCLUSIONS Delayed discharge can never be totally prevented. This unit aims to develop improvement in social work provision, with a greater focus on pre-admission discharge planning to reduce the number of delayed discharges and ultimately reduce the cost burden of joint replacement surgery. It is not conducive with the ethos of fast-track arthroplasty to only identify social circumstances upon admission.
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Affiliation(s)
- R J Napier
- Outcomes Assessment Unit, Musgrave Park Hospital, Stockman's Lane, Belfast BT9 7JB, Northern Ireland, UK.
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Spence D. Author's reply to Scott and colleagues and Gough and Foo. West J Med 2011. [DOI: 10.1136/bmj.d7052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Spence D. Flawed ideology drives the NHS reforms. West J Med 2011. [DOI: 10.1136/bmj.d3076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Spence D. Royal institutions: for better, for worse. West J Med 2011. [DOI: 10.1136/bmj.d2630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Spence D. Child of our time: how childhood now lasts a lifetime. West J Med 2011. [DOI: 10.1136/bmj.d2341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Spence D. Doctors' children. West J Med 2011. [DOI: 10.1136/bmj.d2167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Spence D. Bad medicine: sports medicine. West J Med 2011. [DOI: 10.1136/bmj.d2025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Spence D. We need a Sunshine Act in the UK. West J Med 2011. [DOI: 10.1136/bmj.d1647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Spence D. Sticks and stones? Assoc Med J 2011. [DOI: 10.1136/bmj.d1568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Spence D. Sour grapes: our changing relationship with alcohol. West J Med 2011. [DOI: 10.1136/bmj.d170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Spence D. When marketing masquerades as education. West J Med 2011. [DOI: 10.1136/bmj.c7469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gough A, Spence D, Linden MA, McGarvey L, Halliday H. P76 General and respiratory health outcomes in adult survivors of bronchopulmonary dysplasia: a systematic review. Thorax 2010. [DOI: 10.1136/thx.2010.150979.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Spence D. The art of noise. West J Med 2010. [DOI: 10.1136/bmj.c6038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Spence D. Medical interviews: no further questions. West J Med 2010. [DOI: 10.1136/bmj.c5912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Spence D. Bad medicine: polycystic ovary syndrome. West J Med 2010. [DOI: 10.1136/bmj.c5669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Spence D. Peddling consumption over health: obesity and reality television. West J Med 2010. [DOI: 10.1136/bmj.c5510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Spence D. General practitioners and hospital doctors: the great divide. West J Med 2010. [DOI: 10.1136/bmj.c5343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Spence D. Bad medicine: specialisation. West J Med 2010. [DOI: 10.1136/bmj.c4903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Spence D. The memory class. West J Med 2010. [DOI: 10.1136/bmj.c4761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Spence D. Cervical screening: a smear campaign. West J Med 2010. [DOI: 10.1136/bmj.c4640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Spence D. What junior doctors need. West J Med 2010. [DOI: 10.1136/bmj.c4497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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