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Biomedical subjects

C Johns

Publications and source records attributed to C Johns.

At least 55 records · Page 3Linked to original sources
PubMed1995

The value of reflective practice for nursing.

This paper notes the dawning of reflective practice on the horizon of nursing practice and sets out to explore its value for nursing. Central to this value is the potential of reflective practice to enable practitioners to develop clinical expertise towards achieving desirable and effective practice and, through collaborative research, the development of a valid disciplinary knowledge grounded in practitioners' personal knowledge.

Clinical Competence↗
PubMed1995

Time to care? Time for reflection.

This paper develops a single shared experience within a guided reflection to highlight the process of guiding learning through reflection. The shared experience is a mundane everyday experience concerned with the ward sister on an acute elderly ward responding to a relative's request. From the reflective practice perspective, the analysis of a single experience becomes a significant source of knowledge to inform others' practice. Reflective practitioners always interpret extant knowledge for its relevance to their practice. This process is helped by reflective accounts because they are subjective and contextualized accounts and therefore aid interpretation.

Empathy↗
PubMed1995

Effect of chronic respiratory acidosis on calcium metabolism in the rat.

Chronic metabolic acidosis typically results in hypercalciuria and negative calcium balance. The impact of chronic respiratory acidosis on calcium metabolism has been less well studied. To address this issue, metabolic balance and static bone histomorphometric data were obtained during a 14-day exposure of rats to 10% CO2 (blood pH 7.33, PaCO2 83 mm Hg) and were compared with pair-fed controls. All rats were fed a 0.8% calcium diet. Urinary calcium excretion (mg/period, mean +/- SEM) was increased during both week 1 and week 2 (16 +/- 3 vs 9 +/- 1 and 16 +/- 2 vs 9 +/- 1, CO2 group vs controls, respectively [p < 0.05]). Net intestinal calcium absorption (intake minus fecal excretion) was increased throughout the period of hypercapnia (week 1, 213 +/- 19 mg vs 135 +/- 15 mg; week 2, 135 +/- 16 mg vs 43 +/- 14 mg; and cumulatively, 344 +/- 27 mg vs 178 +/- 20 mg, CO2 group vs controls [p < 0.01]). As a consequence of the marked increment in intestinal calcium absorption during hypercapnia, mean net calcium balance was more positive than that of controls throughout the study (week 1, 197 +/- 18 mg vs 126 +/- 15 mg; week 2, 120 +/- 15 mg vs 34 +/- 15 mg; and cumulatively, 317 +/- 25 mg vs 159 +/- 20 mg, CO2 group vs controls, respectively [p < 0.01]). There were no significant differences in calcium intake, plasma total calcium, immunoreactive parathyroid hormone, 25-hydroxyvitamin D, or creatinine clearance between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Acidosis, Respiratory↗
PubMed1995

Tungiasis.

Explore the source record for details and available documents.

Adult↗
PubMed1994

Implementation of the Ottawa ankle rules.

OBJECTIVE: To assess the impact on clinical practice of implementing the Ottawa ankle rules. DESIGN: Nonrandomized, controlled trial with before-after and concurrent controls. SETTING: Emergency departments of a university (intervention) hospital and a community (control) hospital. PATIENTS: All 2342 adults seen with acute ankle injuries during 5-month periods before and after the intervention. INTERVENTION: The implementation of the Ottawa ankle rules by emergency department physicians. MAIN OUTCOME MEASURE: Proportions of patients referred for standard ankle and foot radiographic series. RESULTS: There was a relative reduction in ankle radiography by 28% at the intervention hospital but an increase by 2% at the control hospital (P < .001). Foot radiography was reduced by 14% at the intervention hospital but increased by 13% at the control hospital (P < .05). Compared with nonfracture patients who had radiography during the after period at the intervention hospital, those discharged without radiography spent less time in the emergency department (80 minutes vs 116 minutes; P < .0001), had lower estimated total medical costs for physician visits and radiography ($62 vs $173; P < .001), but did not differ in the proportion satisfied with emergency physician care (95% vs 96%) or undergoing subsequent radiography (5% vs 5%). The rules were found to have sensitivities of 1.0 (95% confidence interval [CI], 0.95 to 1.0) for detecting 74 malleolar fractures and 1.0 (95% CI, 0.82 to 1.0) for detecting 19 midfoot fractures. In the following 12 months at the intervention hospital, use of radiography did not increase. CONCLUSIONS: Implementation of the Ottawa ankle rules led to a decrease in use of ankle radiography, waiting times, and costs without patient dissatisfaction or missed fractures. Future studies should address the generalizability of these decision rules in a variety of hospital settings.

Adult↗
PubMed1994

The growth of management connoisseurship through reflective practice.

Reflective practice offers a way to structure learning within supervision by paying attention to aspects of practice within reflected experiences, in such ways that the issues can be identified, understood, and worked through to resolve contradictions between desired outcomes and actual practice. In this process, emerging personal knowledge of practice is juxtaposed with relevant theory in such a way that the manager is able to meaningfully assimilate theory into his or her practice as appropriate. This paper illustrates how an H-grade unit nurse manager identified a number of situational management issues through reflecting and sharing experiences in a group clinical supervision milieu (over a period of 15 weeks). Clinical supervision is being advocated as a means to ensure practitioner development of effective practice (Vision for the Future, Department of Health 1993).

Education, Nursing, Continuing↗
PubMed1994

Clinical effects of clozapine in chronic schizophrenia: response to treatment and predictors of outcome.

OBJECTIVE: This study addressed the unique clinical properties attributed to the atypical antipsychotic clozapine, including its efficacy in patients with treatment-refractory psychosis and against negative symptoms, its lack of acute extrapyramidal side effects, and the longer time course of its therapeutic effects. METHOD: The clinical responses of 84 schizophrenic inpatients (66 with treatment-refractory illness and 18 who were intolerant of antipsychotic treatment) were examined. After all previous antipsychotic medications had been withdrawn, the patients were treated with clozapine according to a standardized titration and dosage schedule. Patients who tolerated and responded to treatment were discharged and maintained on a regimen of clozapine for up to 52 weeks. Patients were evaluated for behavioral response and side effects after weeks 3, 6, 12, 26, 39, and 52 of treatment. RESULTS: Fifty percent of the patients with treatment-refractory illness and 76% of the treatment-intolerant patients responded to clozapine in up to 52 weeks. The optimal period for a trial of clozapine appeared to be 12-24 weeks. Clozapine exhibited therapeutic effects on negative symptoms, but these were not clearly independent of its effects on positive symptoms and extrapyramidal side effects. Several variables, including early age at onset of illness and female gender, were found to be predictors of poor response to treatment. Predictors of good response included the presence of extrapyramidal side effects during previous treatment with classic neuroleptics and a diagnosis of paranoid schizophrenia. CONCLUSIONS: These findings have important implications for the use of clozapine and our understanding of the pathophysiology of treatment-resistant schizophrenia.

Adolescent↗
PubMed1994

Clozapine, negative symptoms, and extrapyramidal side effects.

The importance of persistent negative symptoms in schizophrenia as a limiting factor in psychosocial and vocational rehabilitation has been increasingly emphasized. As a result, treatment trials and new drug development programs are focusing more attention on negative symptoms. Unfortunately, there is enormous phenomenological overlap between negative symptoms and neuroleptic-induced parkinsonism. We report data from a cohort of 56 clozapine-treated patients demonstrating significant correlations between measures of akinesia and anergia. Despite an average drug washout of over 2 weeks, the persistence of drug-induced parkinsonism can confound the assessment of therapeutic drug effects on negative symptoms.

Adolescent↗
PubMed1993

Hippocampus-amygdala volumes and psychopathology in chronic schizophrenia.

Volumes of the mesiotemporal structures (hippocampus-amygdala complex) were measured in 19 men who were chronic multiepisode schizophrenics and 18 age-matched healthy controls using T1-weighted contiguous coronal magnetic resonance images of 3.1-mm width. Using the level of the mammillary bodies as an anatomical landmark, the whole hippocampus-amygdala complex was divided into an anterior section (mainly containing amygdaloid tissue) and a posterior section (mainly containing the hippocampal formation). Total mesiotemporal tissue volume was reduced significantly in the patient group compared to controls (-11%), with significant reductions in both left (-20%) and right (-15%) hippocampal sections. Reduced limbic tissue volume was associated with increased severity of psychopathology. Severity of positive psychotic symptoms (Brief Psychiatric Rating Scale [BPRS] psychosis factor) was correlated significantly with right and left total mesiotemporal volumes (Spearman rho's = -0.61 p < 0.01). Negative symptom scores (BPRS anergia factor, Scale for Assessment of Negative Symptoms [SANS] global items) were not significantly correlated with any mesiotemporal tissue volumes. The data corroborate and extend previous findings of temporolimbic structure volume reduction in schizophrenia, and suggest that the positive psychotic symptoms of schizophrenia are associated with anatomic anomalies in mesiotemporal structure.

Adult↗
PubMed1993

Treatment of neuroleptic-resistant schizophrenic relapse.

Preliminary findings are reported for a study of the relative efficacy of conventional treatment alternatives routinely used to treat acutely relapsed schizophrenic patients who fail an initial course of standard neuroleptic therapy. A sample of 156 acutely ill schizophrenic, schizoaffective, and schizophreniform patients who had been hospitalized recently in an acute-care inpatient facility were treated openly with fluphenazine (FPZ) 20 mg/day and with prophylactic benztropine for 4 weeks. Those subjects who failed to meet a priori criteria for substantial therapeutic response at the end of Week 4 were randomized to receive double-blind treatment for an additional 4 weeks with one of the following: (1) the same dose of neuroleptic (FPZ 20 mg/day); (2) an increased dose of neuroleptic (FPZ 80 mg/day); or (3) a different class of neuroleptic (haloperidol 20 mg/day). Of the 115 subjects who completed the open phase of study, 32 percent were identified as responders. Higher negative symptom scores and increased acute extrapyramidal side effect ratings appeared to distinguish the nonresponder from the responder group. Of the nonresponders who went on to randomized treatment, only 4 of 47 subjects (9%) subsequently responded. No superior efficacy was associated with any of the specific alternative treatments studied.

Adolescent↗
PubMed1992

A mitochondrial DNA sequence is associated with abnormal pollen development in cytoplasmic male sterile bean plants.

Cytoplasmic male sterility (CMS) in common bean is associated with the presence of a 3-kb unique mitochondrial sequence designated pvs. The pvs sequence encodes at least two open reading frames (297 and 720 bp in length) with portions derived from the chloroplast genome. Fertility restoration by the nuclear restorer gene Fr results in the loss of this transcriptionally active unique region. We examined the effect of CMS (pvs present) and fertility restoration by Fr (pvs absent) on the pattern of pollen development in bean. In the CMS line, pollen aborted in the tetrad stage late in microgametogenesis. Microspores maintained cytoplasmic connections throughout pollen development, indicating aberrant or incomplete cytokinesis. Pollen-specific events associated with pollen abortion and fertility restoration imply that a gametophytic factor or event may be involved in CMS. In situ hybridization experiments suggested that significant reduction or complete loss of the mitochondrial sterility-associated sequence occurred in fertile pollen of F2 populations segregating for fertility. These observations support a model of fertility restoration by the loss of a mitochondrial DNA sequence prior to or during microsporogenesis/gametogenesis.

Amino Acid Sequence↗
PubMed1991

The Burford Nursing Development Unit holistic model of nursing practice.

This paper offers a new approach for developing a model of nursing emerging from and hence inherently compatible with a philosophy for practice. It builds on the author's earlier work of describing a paradigm for writing a philosophy for practice. The model is that of the Burford Nursing Development Unit in Oxfordshire, England.

Clinical Nursing Research↗
PubMed1990

Arsenic in benthic bivalves of San Francisco Bay and the Sacramento/San Joaquin River Delta.

Arsenic concentrations were determined in fine-grained, oxidized, surface sediments and in two benthic bivalves, Corbicula sp. and Macoma balthica, within San Francisco Bay, the Sacramento/San Joaquin River Delta, and selected rivers not influenced by urban or industrial activity. Arsenic concentrations in all samples were characteristic of values reported for uncontaminated estuaries. Small temporal fluctuations and low arsenic concentrations in bivalves and sediments suggest that most inputs of arsenic are likely to be minor and arsenic contamination is not widespread in the Bay.

Animals↗