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Park J, McGee M, Doran K. 270 Pediatric Emergency Department Family Homelessness Risk Pilot Study. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.228] [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: 10/25/2022]
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McCarthy KN, Ryan NC, O'Shea DT, Doran K, Greene R, Livingstone V, Ryan CA, Boylan GB, Dempsey EM. Parental opinion of consent in neonatal research. Arch Dis Child Fetal Neonatal Ed 2019; 104:F409-F414. [PMID: 30266759 DOI: 10.1136/archdischild-2018-315289] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 04/04/2018] [Revised: 08/28/2018] [Accepted: 08/28/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Neonatal research, particularly neonatal emergency research is a challenging area, notably in relation to obtaining valid prospective informed consent. The aim of this study is to determine parental perceptions of the consent process involved in performing research in newborn care, to explore methods used to obtain consent and their acceptability to parents. METHODS A parental questionnaire was developed that examined attitudes towards research and hypothetical research studies, in which the acceptability of various methods of consent was examined (informed, waived, deferred). These research scenarios were of varying time sensitivity and perceived risk level. The study setting was an Irish maternity hospital. RESULTS There were 600 responses to the questionnaire. In 93% of cases, parents felt that their involvement in the consent process was essential. In emergency situations, 52% felt full prospective informed consent was necessary; however, almost 28% of parents would feel pressure to consent. Most (75%) parents would prefer to be approached to discuss neonatal research studies antenatally, irrespective of study type and 40% of parents felt that neonates involved in research studies received overall better care. Acceptability of deferred consent was greater than waived, and was highest for the more emergency-based scenarios presented. DISCUSSION Parents feel that they should play a central role in research involving their children. There were differences in the acceptability of various consent methods with strongest agreement for informed consent and lowest agreement for waived consent. Parents were more willing to accede to deferred consent in the cardiopulmonary resuscitation scenario study. These findings provide useful insights to consent strategies in future newborn research studies.
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Affiliation(s)
- Karen Nora McCarthy
- Department of Paediatrics and Child Health, Neonatal Intensive Care Unit, Cork University Maternity Hospital, Cork, Ireland
| | - Niamh C Ryan
- Department of Paediatrics and Child Health, Neonatal Intensive Care Unit, Cork University Maternity Hospital, Cork, Ireland
| | - Darragh T O'Shea
- Department of Paediatrics and Child Health, Neonatal Intensive Care Unit, Cork University Maternity Hospital, Cork, Ireland
| | - Kieran Doran
- School of Medicine and Health, University College Cork, Cork, Ireland
| | - Richard Greene
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - Vicki Livingstone
- Department of Paediatrics and Child Health, Neonatal Intensive Care Unit, Cork University Maternity Hospital, Cork, Ireland
| | - C Anthony Ryan
- Department of Paediatrics and Child Health, Neonatal Intensive Care Unit, Cork University Maternity Hospital, Cork, Ireland
| | - Geraldine B Boylan
- Department of Paediatrics and Child Health, Neonatal Intensive Care Unit, Cork University Maternity Hospital, Cork, Ireland
| | - Eugene M Dempsey
- Department of Paediatrics and Child Health, Neonatal Intensive Care Unit, Cork University Maternity Hospital, Cork, Ireland
- INFANT, Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
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O'Shea N, Doran K, Ryan CA, Dempsey E. Parental And Clinician Views Of Consent In Neonatal Research. Ir Med J 2018; 111:706. [PMID: 30376224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM To determine parental and clinician views of the informed consent process in neonatal research. METHODS A questionnaire-based study on the informed consent process. Two questionnaires were developed and distributed to parents and clinicians over a four-month period. RESULTS Thirty-four parents (79%) surveyed had consented their baby to a research study. The majority of clinicians (72%) had a preference for antenatal provision of information. A desire to help future babies (97%, n=32) and a belief that their baby's healthcare would directly benefit (72%, n=28) were primary reasons for consenting. The majority (76% n=28) of parents were not in favour of a waiver of consent. However twenty clinicians (56%) agreed that a waiver of consent may be appropriate in neonatal research. Thirty-one (86%) clinicians rated GCP training as important. DISCUSSION Parents are generally supportive of neonatal research. Good clinical practice training is essential for clinicians involved in neonatal research.
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Affiliation(s)
- N O'Shea
- Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, Neonatal Intensive Care Unit, Wilton, Cork, Ireland
| | - K Doran
- School of Medicine, University College Cork, Cork, Ireland
| | - C A Ryan
- Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, Neonatal Intensive Care Unit, Wilton, Cork, Ireland
| | - E Dempsey
- Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, Neonatal Intensive Care Unit, Wilton, Cork, Ireland
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O'Reilly M, O'Tuathaigh CMP, Doran K. Doctors' attitudes towards the introduction and clinical operation of do not resuscitate orders (DNRs) in Ireland. Ir J Med Sci 2017; 187:25-30. [PMID: 28508956 DOI: 10.1007/s11845-017-1628-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 04/27/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Do not resuscitate orders (DNRs) are documents which state that should a patient suffer from cardiopulmonary failure, resuscitation should not be attempted. Internationally, DNRs are often misunderstood and used inappropriately in a clinical setting. AIMS The aim of this paper was to determine the current understanding of DNRs and their clinical operation among hospital doctors in Ireland. METHODS A cross-sectional, questionnaire-based study was conducted involving doctors from the Cork teaching hospitals. The questionnaire sought information regarding understanding of DNRs and their clinical operation, as well as attitudes regarding the current absence of relevant Irish guidelines. The questionnaire also collected information regarding demographics, clinical specialty, and level of experience. RESULTS 45.9% (47/103) of all doctors stated that their clinical knowledge was sufficient to draft a DNR, but 48.7% of this group (n = 23) chose the incorrect definition for a DNR when provided with three separate options. Thirty-five percent (n = 36) of all doctors surveyed demonstrated an incorrect understanding of a DNR. Neither specialty nor experience level had any effect on level of understanding of DNRs (p > 0.05). 93.2% (n = 96) agreed that there is a need for introduction of domestic guidelines regarding DNRs. 57.6% (n = 59) would draft more DNRs in the event that such domestic guidelines were in place. CONCLUSIONS A substantial proportion of hospital doctors surveyed demonstrated an incomplete understanding of DNRs and their clinical operation. However, the overwhelming majority of the present sample believe that domestic guidelines are needed on the matter.
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Affiliation(s)
- M O'Reilly
- School of Medicine, Brookfield Health Sciences Complex, University College Cork, College Road, Cork, Ireland
| | - C M P O'Tuathaigh
- School of Medicine, Brookfield Health Sciences Complex, University College Cork, College Road, Cork, Ireland.
| | - K Doran
- School of Medicine, Brookfield Health Sciences Complex, University College Cork, College Road, Cork, Ireland
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Doran J, Remeny B, Ilton M, Canty D, Cass A, Dempsey K, Townsend R, Royse C, Royse A, Kaethner A, Brunsdon G, Boardmann C, Bennets J, Baker R, Oatway S, Thiele B, Perry D, Doran K, Doran U, Grey N, Kangaharan N. Retrospective Audit of Rheumatic Heart Valve Surgical Outcomes in the Top End of Northern Territory, Australia. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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O'Grady K, Doran K, O'Tuathaigh CMP. Attitudes towards abortion in graduate and non-graduate entrants to medical school in Ireland. J Fam Plann Reprod Health Care 2015; 42:201-7. [DOI: 10.1136/jfprhc-2015-101244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 09/15/2015] [Indexed: 11/03/2022]
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Maher B, Hynes H, Sweeney C, Khashan A, Doran K, O'Rourke M, Harris AM, O'Flynn S. The at-risk medical student--what more can we do? Ir Med J 2014; 107:295-296. [PMID: 25417393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Securing a place in medical school is extremely difficult-students who are successful all have similar high levels of academic achievement. So why do some students, and not others, have difficulty with the course, and in some cases, leave the programme? Studies on medical school attrition offer valuable insight into why medical students under-perform. Identification of the 'at-risk' student can trigger additional support and early remediation, helping some students remain in their chosen profession.
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Maher BM, Hynes H, Sweeney C, Khashan AS, O’Rourke M, Doran K, Harris A, Flynn SO. Medical school attrition-beyond the statistics a ten year retrospective study. BMC Med Educ 2013; 13:13. [PMID: 23363547 PMCID: PMC3565981 DOI: 10.1186/1472-6920-13-13] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 01/21/2013] [Indexed: 05/17/2023]
Abstract
BACKGROUND Medical school attrition is important--securing a place in medical school is difficult and a high attrition rate can affect the academic reputation of a medical school and staff morale. More important, however, are the personal consequences of dropout for the student. The aims of our study were to examine factors associated with attrition over a ten-year period (2001-2011) and to study the personal effects of dropout on individual students. METHODS The study included quantitative analysis of completed cohorts and qualitative analysis of ten-year data. Data were collected from individual student files, examination and admission records, exit interviews and staff interviews. Statistical analysis was carried out on five successive completed cohorts. Qualitative data from student files was transcribed and independently analysed by three authors. Data was coded and categorized and key themes were identified. RESULTS Overall attrition rate was 5.7% (45/779) in 6 completed cohorts when students who transferred to other medical courses were excluded. Students from Kuwait and United Arab Emirates had the highest dropout rate (RR = 5.70, 95% Confidence Intervals 2.65 to 12.27;p < 0.0001) compared to Irish and EU students combined. North American students had a higher dropout rate than Irish and EU students; RR = 2.68 (1.09 to 6.58;p = 0.027) but this was not significant when transfers were excluded (RR = 1.32(0.38, 4.62);p = 0.75). Male students were more likely to dropout than females (RR 1.70, .93 to 3.11) but this was not significant (p = 0.079).Absenteeism was documented in 30% of students, academic difficulty in 55.7%, social isolation in 20%, and psychological morbidity in 40% (higher than other studies). Qualitative analysis revealed recurrent themes of isolation, failure, and despair. Student Welfare services were only accessed by one-third of dropout students. CONCLUSIONS While dropout is often multifactorial, certain red flag signals may alert us to risk of dropout including non-EU origin, academic struggling, absenteeism, social isolation, depression and leave of absence. Psychological morbidity amongst dropout students is high and Student Welfare services should be actively promoted. Absenteeism should prompt early intervention. Behind every dropout statistic lies a personal story. All medical schools have a duty of care to support students who leave the medical programme.
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Affiliation(s)
- Bridget M Maher
- School of Medicine, College of Medicine and Health, Brookfield Health Sciences Complex, University College Cork, College Road, Cork, Ireland
| | - Helen Hynes
- School of Medicine, College of Medicine and Health, Brookfield Health Sciences Complex, University College Cork, College Road, Cork, Ireland
| | - Catherine Sweeney
- School of Medicine, College of Medicine and Health, Brookfield Health Sciences Complex, University College Cork, College Road, Cork, Ireland
| | - Ali S Khashan
- School of Medicine, College of Medicine and Health, Brookfield Health Sciences Complex, University College Cork, College Road, Cork, Ireland
| | - Margaret O’Rourke
- School of Medicine, College of Medicine and Health, Brookfield Health Sciences Complex, University College Cork, College Road, Cork, Ireland
| | - Kieran Doran
- School of Medicine, College of Medicine and Health, Brookfield Health Sciences Complex, University College Cork, College Road, Cork, Ireland
| | - Anne Harris
- School of Medicine, College of Medicine and Health, Brookfield Health Sciences Complex, University College Cork, College Road, Cork, Ireland
| | - Siun O’ Flynn
- School of Medicine, College of Medicine and Health, Brookfield Health Sciences Complex, University College Cork, College Road, Cork, Ireland
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Doran K. A case study of non-binding mediation in practice: Rush-Presbyterian-St. Luke's Medical Centre, Chicago, Medical Malpractice Mediation Programme: continued.... Ir Med J 2000; 93:25. [PMID: 10740372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- K Doran
- Healthcare Risk Resources International Limited, London
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Doran K. A case study of non-binding mediation in practice: Rush-Presbyterian-St. Luke's Medical Centre, Chicago, medical malpractice mediation programme. Ir Med J 1999; 92:436. [PMID: 10967868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- K Doran
- Healthcare Risk Resources International Limited, London
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Rodgers S, Avery AJ, Meechan D, Briant S, Geraghty M, Doran K, Whynes DK. Controlled trial of pharmacist intervention in general practice: the effect on prescribing costs. Br J Gen Pract 1999; 49:717-20. [PMID: 10756613 PMCID: PMC1313499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND It has been suggested that the employment of pharmacists in general practice might moderate the growth in prescribing costs. However, empirical evidence for this proposition has been lacking. We report the results of a controlled trial of pharmacist intervention in United Kingdom general practice. AIM To determine whether intervention practices made savings relative to controls. METHOD An evaluation of an initiative set up by Doncaster Health Authority. Eight practices agreed to take part and received intensive input from five pharmacists for one year (September 1996 to August 1997) at a cost of 163,000 Pounds. Changes in prescribing patterns were investigated by comparing these practices with eight individually matched controls for both the year of the intervention and the previous year. Prescribing data (PACTLINE) were used to assess these changes. The measures used to take account of differences in the populations of the practices included the ASTRO-PU for overall prescribing and the STAR-PU for prescribing in specific therapeutic areas. Differences between intervention and control practices were subjected to Wilcoxon matched-pairs, signed-ranks tests. RESULTS The median (minimum to maximum) rise in prescribing costs per ASTRO-PU was 0.85 Pound (-1.95 Pounds to 2.05 Pounds) in the intervention practices compared with 2.55 Pounds (1.74 Pounds to 4.65 Pounds) in controls (P = 0.025). Had the cost growth of the intervention group been as high as that of the controls, their total prescribing expenditure would have been around 347,000 Pounds higher. CONCLUSION This study suggests that the use of pharmacists did control prescribing expenditure sufficiently to offset their employment costs.
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Affiliation(s)
- S Rodgers
- Division of General Practice, Medical School, Queen's Medical Centre, Nottingham
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Doran K. Civil justice reforms in England: the Woolf Report and the Pre-Action Protocol. Ir Med J 1999; 92:342. [PMID: 10453116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- K Doran
- Healthcare Risk Resources International Ltd., London
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Doran K. The issue of consent in medical law: exceptions to the informed consent rule. Ir Med J 1999; 92:245. [PMID: 10360100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Affiliation(s)
- K Doran
- Division of Legal Medicine, University College Dublin
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Doran K. The issue of informed consent in medical law. Ir Med J 1998; 91:214. [PMID: 10069132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- K Doran
- Division of Legal Medicine, University College Dublin
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Doran K. Patient access to medical records. Ir Med J 1998; 91:179. [PMID: 9973756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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Doran K. When a physician is HIV positive. An examination of legal and practical aspects. QRC Advis 1998; 14:4-12. [PMID: 10181889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Doran K. The defence of consent to the tort of battery. Ir Med J 1998; 91:98. [PMID: 9695433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- K Doran
- Division of Legal Medicine, University College Dublin, Earlsfort Terrace
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Doran K. Medical negligence: claims against doctors. Ir Med J 1998; 91:63. [PMID: 9617034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- K Doran
- Division of Legal Medicine, University College, Dublin
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Doran K. The legislative position governing patient access to medical records. Ir Med J 1998; 91:27. [PMID: 9563253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- K Doran
- Division of Legal Medicine, University College Dublin
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Doran K. The capacity of minors to consent to medical treatment: Section 23 of the Non-Fatal Offences Against the Person Act 1997. Ir Med J 1997; 90:254. [PMID: 10036814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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Doran K. Exceptions to the duty of confidentiality. Ir Med J 1997; 90:273. [PMID: 10036823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
- K Doran
- Division of Legal Medicine, University College Dublin
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Doran K. Medical confidentiality in the doctor-patient relationship. Ir Med J 1997; 90:239. [PMID: 9611929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- K Doran
- Division of Legal Medicine, Faculty of Medicine, University College, Dublin
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Abstract
The aim of this research was to describe the distribution of place of death for cancer. An analysis of place of death for all 831 cancer deaths in 1995 among Doncaster Health Authority's residents was carried out. The data were extracted using the Public Health Mortality File. It was found that there is statistically significant evidence that place of death is associated with social class. Social class I and II with 15% of all cancer deaths contributed 24% of hospice deaths, 14% of hospital deaths and 12% of home deaths. Social class III with 24% of all cancer deaths contributed 58% of hospice deaths, only 9% of hospital deaths and 35% of home deaths. Social classes IV and V with 61% of cancer deaths contributed only 18% of hospice deaths, 77% of hospital deaths and 53% of home deaths. The reasons for these differences may be to do with access to services, perceptions of different services by patients and general practitioners and the availability of social support within different sections of the community.
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Affiliation(s)
- A Sims
- St John's Hospice, Doncaster, UK
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Abstract
Many patients who receive medical interventional cardiology procedures at a tertiary hospital live outside the metropolitan area and may experience fragmentation in care, less emotional support by family members, inaccurate and delayed communication, and lack of educational follow-up on discharge from the hospital. A clinical pathway titled "Heart Health Care Patterns" was developed to link acute phase, recovery phase, rehabilitation phase, and enhancement/maintenance phase. The 12-month clinical pathway combines Gordon's Functional Health Patterns and the Omaha System developed by the Omaha Visiting Nurse Association. The rating scale for outcomes assesses the patient at different phases to provide objective data and information throughout the year.
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Affiliation(s)
- K Doran
- Cardiac Center at Mercy Hospital, Coon Rapids, Minnesota, USA
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Thompson JA, Blakesley RW, Doran K, Hough CJ, Wells RD. Purification of nucleic acids by RPC-5 ANALOG chromatography: peristaltic and gravity-flow applications. Methods Enzymol 1983; 100:368-99. [PMID: 6194408 DOI: 10.1016/0076-6879(83)00068-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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