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Biomedical subjects

C Johns

Publications and source records attributed to C Johns.

At least 73 records · Page 4Linked to original sources
PubMed1990

Autonomy of primary nurses: the need to both facilitate and limit autonomy in practice.

This paper explores the concept and implications of autonomy in relation to primary nurses. It explores the need to limit this autonomy to ensure assigned patients receive a consistent and congruent quality of care. Methods that enable primary nurses to demonstrate their pluralistic accountability, currently being used and tested in practice, are described, methods that limit the autonomy of primary nurses without compromising it.

Humanism↗
PubMed1990

Implementing a philosophy of care on a children's ward using action research.

This paper charts the progress of an action research project initially implemented to assist the staff of a pediatric ward in the development of primary nursing. The use of ward meetings to identify needs and clarify objectives is discussed; from this emerged a broader remit to implement the ward's philosophy of care. Five areas of clinical practice development were identified for work: development of a staff development strategy, identification of resource people, movement to primary nursing, development of standards of care, and development of the ward environment. Progress in these five areas is explored, and the use of evaluation strategies such as visual analogue scales, unstructured interviews and personal diaries are discussed. Description and discussion of some of the difficulties associated with this project are given. In conclusion, the authors address the issue of whether action research is in fact a specific methodology or a philosophy.

Clinical Nursing Research↗
PubMed1990

Nursing practice. Developing a philosophy.

Christopher Johns, in Part 2 of this article, illustrates the process of defining a nursing philosophy. A case study is used to illustrate how clinical nurses can set about defining a philosophy of nursing for themselves.

Humans↗
PubMed1989

Clozapine pharmacology and tardive dyskinesia.

Clozapine, an atypical neuroleptic, does not cause extrapyramidal symptoms of Parkinsonism and dystonia and appears to have a reduced or absent capacity to produce tardive dyskinesia. 37 subjects, most with chronic schizophrenia, were treated with clozapine and TD outcome was analyzed. A subset of these subjects underwent plasma and CSF studies. TD response was heterogenous, but a proportion of patients improved with clozapine treatment. Neurochemical data differed from published reports of classical neuroleptics with the most robust effect produced by clozapine seen in CSF norepinephrine levels. Other neurochemical data and implications for the mechanism of clozapine in TD are reviewed.

Adolescent↗
PubMed1989

Nursing practice. Developing a philosophy.

The application of nursing models has been a recent theme in British nursing. Part of this process is the development of a nursing philosophy which underpins the model. Nurses at clinical level are often required to define their philosophy to meet clinical, educational and managerial objectives. The first part of this two-part article explores the significance of nursing philosophy to practice. In the second part, a case study is used to illustrate how clinical nurses can set about defining a philosophy of nursing for themselves. Dickoff et al (1) indicate that a philosophy is significant in the generation of theory. By identifying the nature of practice, theoretical relationships become apparent. It is also significant as Johnson (2) states in nursing's development as a profession. Johnson further asserts that nurses should use their beliefs to build a conceptual system of the person to be served and an abstract model for practice which allows such purpose to be fulfilled. However a nurse's beliefs and values about nursing may have no theoretical substance to them. They may be purely intuitive in nature. Writing a philosophy legitimates intuition. Kitson (3) considers that nurse theorists who believe that only developing a knowledge base through a scientific approach are at risk of throwing away the intuitive sources of knowledge within nursing. Yet gut reactions have been shown to be critical in the development of excellence in nursing (4). Kitson believes that intuitions can lead to developing 'grassroots standards of care' and a clearer definition of what nursing is.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1988

Pharmacologic studies of tardive dyskinesia.

Based on the results of two preliminary studies, we concluded that late-developing persistent drug-induced movement disorders are pharmacologically heterogeneous, and this heterogeneity is seen between individual patients (and groups of patients) as well as within body areas of individual patients; dystonic pathology has a distinct and more consistent response to pharmacologic stimulation than does nondystonic tardive dyskinesia (TD); and, although disturbances in dopamine and acetylcholine appear to be involved in these disorders, they do not in all cases exist in functionally opposite relationships. The observed pharmacologic heterogeneity in TD response reflects the limitations of the dopamine/acetylcholine model of TD, which oversimplifies the neuroanatomy of the basal ganglia and the pathophysiology of TD. The chemical and anatomical complexity of this region suggests that other neurotransmitter systems and neuronal circuits within and extending from the basal ganglia may be disturbed in the pathogenesis of TD.

Adult↗
PubMed1986

Prostaglandin receptor sensitivity in psychiatric disorders.

The cyclic adenosine monophosphate (cAMP) responses to prostaglandin E1 (PGE1) in platelets and leukocytes from drug-free schizophrenic patients, depressive patients, and normal controls have been compared. Both schizophrenic and depressive patients had a significantly lower platelet cAMP response to PGE1 than controls. The platelet cAMP response to PGE1 did not discriminate among exacerbated, remitted, and poor-prognosis schizophrenic patients, or between exacerbated and remitted depressive patients. The cAMP response to PGE1 was negatively correlated with global symptom severity in actively ill schizophrenic patients, but was not correlated with symptom severity in exacerbated depressive patients. The leukocyte cAMP response to PGE1 did not differ among normal controls, schizophrenic patients, and depressive patients. These data indicate that a diminished platelet cAMP response to PGE1 may be a marker common to both schizophrenia and depression but that this effect does not extend to a cAMP-linked PGE1 receptor on another blood cell type.

Adult↗
PubMed1985

Sarcoidosis and its neurological manifestations.

Neurosarcoidosis is a disorder that is difficult to diagnose and manage. We assessed its neurological manifestations in 649 patients seen at The Johns Hopkins Hospital, Baltimore, from 1975 through 1980. Neurological problems could be attributed to neurosarcoidosis in 33 patients (5.1%). The presenting manifestation of sarcoidosis was neurological in 16 (48%) of them. Cranial neuropathy was the most frequent problem, and a peripheral facial nerve palsy was the single most common abnormality. Other manifestations were aseptic meningitis, hydrocephalus, parenchymatous disease of the central nervous system, peripheral neuropathy, and myopathy. Three-quarters of the patients were treated with steroids. The outcome was good in 27 (82%) of 33 episodes of neurological dysfunction in 25 patients with a well-documented clinical course. A thorough investigation of patients with suspected neurosarcoidosis is recommended to establish the diagnosis, delineate the extent of disease, and guide therapy.

Adult↗
PubMed1985

Encopresis.

Explore the source record for details and available documents.

Child, Preschool↗
PubMed1982

PCO2 measurements in surface proximal tubules and peritubular capillaries of the rat kidney.

PCO2 was measured in surface proximal tubules and peritubular capillaries in the rat under normal acid-base conditions and in three settings with decreased HCO3(-) reabsorption: benzolamide administration, respiratory alkalosis, and metabolic acidosis. Under normal conditions, PCO2 in the early proximal tubule (EP) was 10.5 mmHg higher than PaCO2 (P less than 0.001) and 3-4 mmHg higher than late proximal (LP) and peritubular capillary (PC) PCO2 (P less than 0.001). PCO2 in LP and PC was 7 mmHg higher than PaCO2 (P less than 0.001). Benzolamide (3 mg/kg) had no effect on the difference between PC and arterial PCO2 or between EP and PC PCO2. Increasing benzolamide to 8 mg/kg increased PCO2 in the surface structures relative to arterial PCO2 by 3-5 mmHg (P less than 0.01). Metabolic acidosis did not alter the relationships between cortical and arterial PCO2. By contrast, respiratory alkalosis decreased cortical PCO2 relative to PaCO2 by over 50%. Nonetheless, EP PCO2 was still higher than LP or PC PCO2 (P less than 0.01). Thus, reducing HCO3(-) reabsorption does not obliterate the difference between EP and LP or PC PCO2 nor does it invariably reduce PCO2 in the surface structures of the kidney relative to arterial PCO2.

Animals↗
PubMed1981

Dissociation of saline-induced natriuresis from urea washout in the rat.

Medullary urea washout has been postulated to play a major role in the natriuretic response to volume expansion (VE). To examine this hypothesis, renal tissue solute composition was measured in a natriuretic and nonnatriuretic model of VE. Renal tissue composition was analyzed during hydropenia, acute VE, acute VE with renal artery pressure reduced to 70 mmHg at the onset of saline loading (immediate clamping), and acute VE with renal artery pressure reduced to 70 mmHg after 45 min of saline loading (delayed clamping). Immediate clamping, a nonnatriuretic model of VE, prevented VE-induced urea washout and the increase in sodium and water content in the cortex and outer medulla. Delayed clamping, a natriuretic model of VE, produced a pattern of tissue composition very similar to immediate clamping. Tissue urea content was not significantly different in the two protocols and only minor differences in sodium and water content were noted. Thus, under these experimental conditions, VE-induced natriuresis can be dissociated from medullary urea washout, and other mechanisms must be invoked to explain the increased sodium excretion.

Animals↗
PubMed1980

Effect of benzolamide on pH in the proximal tubules and peritubular capillaries of the rat kidney.

The influence of carbonic anhydrase inhibition with benzolamide on proximal tubular and peritubular capillary pH was evaluated in the rat using a glass-membrane pH microelectrode. Control peritubular capillary pH, 7.38 +/- .02 (N=11), was significantly lower than control arterial pH, 7.44 +/- .01, p < .05. Early proximal tubular pH, 7.20 +/- .02 (N = 17), was more alkaline than late proximal tubular pH, 6.74 +/- .06 (N = 13), p < .001; pH at both sites was more acid than in the peritubular capillary, p < .001. Benzolamide treatment had no detectable effect on arterial or peritubular capillary pH, but reduced early proximal tubular pH by 0.54 pH units, to 6.66 +/- .04 (N = 13), p < .001. Late proximal pH also fell slightly to 6.57 +/- .03 (N = 14), p < .02. The results support previous observations indicating that benzolamide treatment decreases early proximal tubular pH dramatically, and provide further evidence that HCO3- reabsorption is accomplished by hydrogen ion secretion in the proximal tubule.

Animals↗
PubMed1979

Macrophage-related suppressor cells in human renal transplant recipients.

In this study 66 renal transplant recipients were studied by in vitro immunologic monitoring assays in an attempt to delineate some immune reactivity parameters which migh explain the successful long-term survival of HLA incompatible allografts. Ninety percent of the recipients were found to be responsive to their specific donors in one-way mixed lymphocyte culture assays, indicating the presence of antigen reactive proliferating T cells. In contrast, studies of the in vitro generation of cytotoxic T cells showed that 73% of the long-term recipients demonstrated a marked hyporesponsiveness to the donor in cell-mediated lympholysis (CML) assays. Longitudinal studies indicated that specific CML hyporesponsiveness to the donor developed after transplantion. In the majority of recipients, CML hyporesponsiveness could be related to a suppressor cell phenomenon, since recipient mononuculear cells specifically suppressed the CML reactivity of third-party cells to the donor. Recipient CML hyporesponsiveness to the donor could be abrogated by removal of recipient adherent cells, most of which were monocytes or macrophages. The suppressor cell effect on CML is postulated to be related to macrophages which are either acting independently or under the regulation of suppressor T cells. These studies are among the first to suggest that suppressor cell regulation of relevant effector T cell activity may be important in the facilitation of successful human renal transplantation.

Cell Adhesion↗
PubMed1977

Coordination of care and its relationship to continuity and medical records.

Introduction of a computerized printout ("mini record") containing problems and therapies, and listing visits between regularly scheduled ones to a primary care facility, resulted in improved recognition of problems and therapies. Recognition both of the occurrence of the visits which had been made elsewhere and the content of those visits was not improved, even though the mini record listed the dates and place of visit. Recognition was improved more in situations where the practitioners in the primary care clinic changed than when the practitioner remained the same individual who had seen the patient at the previous visit to the primary care clinic. Coordination of care is an essential ingredient of primary care. Recognition of all information generated by patients in a series of visits is evidence of coordination. Continuity (whether achieved by continuity of practitioner or by medical records) is one means of attaining better coordination. In a previous study we showed that continuity of practitioner improves coordination. This study shows that a technologic innovation consisting of an alteration in medical records facilitates coordination, but only with regard to certain aspects of care. Explanations for this finding are postulated.

Adult↗