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Biomedical subjects

J Carson

Publications and source records attributed to J Carson.

At least 55 records · Page 3Linked to original sources
PubMed1996

First steps towards evaluating clinical supervision in nursing and health visiting. I. Theory, policy and practice development. A review.

The subject of clinical supervision for nurses and health visitors in the UK is considered in this paper. The paper highlights recent debates in thinking and rapid developments in practice. The original concept of clinical supervision, its theoretical propositions and development, recent policy influences and current strategies for evaluation are debated.

Community Health Nursing↗
PubMed1996

Stress, coping and burnout in mental health nurses: findings from three research studies.

In this paper we present data from three research studies on stress, coping and burnout in mental health nurses. All three studies used a range of self report questionnaires. Measures included a demographic checklist, the General Health Questionnaire (GHQ-28), the Maslach Burnout Inventory, the DCL Stress Scale and the Cooper Coping Skills Scale. In all, 648 ward based mental health nurses were surveyed. There were no significant differences between levels of psychological distress on GHQ Total Score, but there were differences in caseness rates. In Study 3, some 38% of nurses were found to score at or above the criterion for caseness. The main stressors for ward staff were to do with staff shortages, health service changes, poor morale and not being notified of changes before they occurred. Differences in coping skills were found across studies. The study group with the highest stress scores also had the lowest coping skills scores. This was also associated with significantly higher alcohol consumption and greater self reported sickness absence. Scores on the Maslach Burnout Inventory showed higher levels of burnout amongst nurses in Study 3. These three studies have confirmed that stress is a problem for ward based mental health nurses. Two main implications arise from this work. Firstly we need models of the stress process that are empirically based, and which help us identify the moderating variables that reduce the impact of stressors on nurses. Secondly, we need to utilise this knowledge to deliver stress management interventions for staff. We end by outlining a model which may help us both understand the process of stress causation, and move towards our goal of stress reduction.

Adaptation, Psychological↗
PubMed1996

Improved local control of invasive bladder cancer by concurrent cisplatin and preoperative or definitive radiation. The National Cancer Institute of Canada Clinical Trials Group.

PURPOSE: A prospective randomized trial was conducted to determine whether the addition of concurrent cisplatin to preoperative or definitive radiation therapy in patients with muscle-invasive bladder cancer improved local control or survival. PATIENTS AND METHODS: Ninety-nine eligible patients with T2 to T4b transitional cell bladder cancer participated, 64% with cT3b or cT4. Patients and their physicians selected either definitive radiotherapy or precystectomy radiotherapy; patients were then randomly allocated to receive intravenous cisplatin 100 mg/m2 at 2-week intervals for three cycles concurrent with pelvic radiation, or to receive radiation without chemotherapy. Patients were stratified by clinical tumor stage and by radiation plan. The median follow-up duration is 6.5 years. RESULTS: The occurrence of distant metastases was the same in both study arms. However, 25 of 48 control patients have had a first recurrence in the pelvis, compared with 15 of 51 cisplatin-treated patients (P = .036). The pelvic relapse rate in the two groups was significantly reduced by concurrent cisplatin (P = .038, log-rank test) and this effect was preserved in a stepwise Cox regression model of prognostic factors (hazards ratio, 0.50; 90% confidence interval [CI], 0.29 to 0.86; P = .036). The hazard reduction was similar for both radiation plans. Pretreatment leukocytosis and high clinical stage were independent adverse factors in a Cox model of overall survival, but the effect of cisplatin was not significant. CONCLUSION: Concurrent cisplatin may improve pelvic control of locally advanced bladder cancer with preoperative or definitive radiation, but has not been shown to improve overall survival. The use of concurrent cisplatin had no detectable effect on distant metastases.

Adult↗
PubMed1995

Insulin-like growth factor-I influences the initiation of myelination: studies of the anterior commissure of transgenic mice.

The effects of insulin-like growth factor-I (IGF-I) on the initiation of myelination have been examined in the posterior portion of anterior commissure of the transgenic (Tg) mice that overexpress IGF-I in brain, and those which exhibit ectopic brain expression of IGF binding protein-1 (IGFBP-1), an inhibitor of IGF actions. In IGF-I Tg mice the number of ensheathed axons was increased compared to their normal littermates. The distribution of the axon size further showed that both small (< 300 nm) and large (> 700 nm) axons were more often ensheathed and myelinated. The opposite was true in IGFBP-1 Tg mice. These data indicate that IGF-I increases myelin ensheathment independent of axon diameter, and support the hypothesis that the absolute axon size is not the sole determinant for the initiation of myelination in CNS.

Age Factors↗
PubMed1995

The Claybury Community Psychiatric Nurse Stress Study: is it more stressful to work in hospital or the community?

The Claybury community psychiatric nurse (CPN) stress study collected data on stress levels in 250 CPNs and 323 ward-based psychiatric nurses (WBPN) in the North East Thames region. Four out of 10 CPNs were found to be experiencing high levels of psychological distress on GHQ scores. Whilst both CPNs and WBPNs scored highly on scores of occupational burnout, especially on emotional exhaustion scores, WBPNs scored worse on emotional detachment from their patients and were achieving less personal fulfilment from their work. Both groups of nurses were more satisfied with direct patient clinical work than with their employment conditions, particularly their working environments and, for CPNs, their relationships with their managers. The different patterns of coping skills are explored and discussed for both groups of nurses, especially the use of social support, time management and organization of tasks. The study concludes that whilst major changes are occurring in the psychiatric arena for both groups of nurses, stress is reaping its toll on mental health nurses, in terms of higher absence rates, lower self-esteem and personal unfulfilment. This could not only affect the quality of patient care but also future career prospects for nurses. The study invites serious consideration of introducing stress-reducing measures in the work-place as well as further research into specific stressors for different groups of nurses.

Adaptation, Psychological↗
PubMed1995

Stress and coping strategies in community psychiatric nurses: a Q-methodological study.

With the development of the concept of community care there has been a significant expansion of the community psychiatric nurse (CPN) profession. The present study attempts to examine which aspects of their work CPNs currently find stressful. The study also examines the various strategies which CPNs feel to be useful in attempting to cope with such occupational stress. Forty-four CPNs in four health districts participated in this Q-methodological study which provided the opportunity for CPNs to construct their own concepts of stressors and coping strategies. The results obtained indicated that CPNs identified nine distinct areas of stress within their work, along with 12 distinct coping strategies which they considered useful in attempting to deal with such stress. The implications of these findings are discussed.

Adaptation, Psychological↗
PubMed1995

Stress and the community mental health nurse: the development of a measure.

The issue of stress amongst health care professionals is currently a major concern within the British National Health Service. It is important for researchers to develop both reliable and valid psychometric measures to assess occupational stress. This paper outlines the development and piloting of a measure of professional stress for community mental health nurses, the CPN Stress Questionnaire (Revised). Data on the reliability and validity of this new measure are presented. It is concluded that this measure has good psychometric properties. A range of possible research applications is outlined.

Burnout, Professional↗
PubMed1995

In vivo actions of insulin-like growth factor-I (IGF-I) on brain myelination: studies of IGF-I and IGF binding protein-1 (IGFBP-1) transgenic mice.

To study the effects and mechanisms of insulin-like growth factor I (IGF-I) on brain myelination in vivo, the morphology of myelinated axons and the expression of myelin specific protein genes have been examined in transgenic (Tg) mice that overexpress IGF-I and that those ectopically express IGF binding protein-1 (IGFBP-1), a protein that inhibits IGF-I actions when present in molar excess. Our data show that the percentage of myelinated axons and the thickness of myelin sheaths are significantly increased in IGF-I Tg and decreased in the IGFBP-1 mice. Cerebral cortical proteolipid protein (PLP) and myelin basic protein (MBP) mRNAs consistently exhibit approximately 200% increases in IGF-I Tg mice and approximately 50% decreases in IGFBP-1 Tg mice. The percentage of oligodendrocytes labeled with a PLP cRNA probe in the corpus callosum and cerebral cortex also is increased in IGF-I Tg mice and reduced in IGFBP-1 Tg mice, suggesting that IGF-I promotes oligodendrocyte survival and/or proliferation. The alterations in the number of oligodendrocytes, however, can not completely account for the changes in myelin gene expression. These results strongly indicate that IGF-I increases myelination by increasing the number of myelinated axons and the thickness of myelin sheaths, the latter by mechanisms that involve stimulation of the expression of myelin protein genes and increase of oligodendrocyte number.

Animals↗
PubMed1994

Diagnostic ultrasound in pregnancy and low birthweight.

Diagnostic ultrasound has been used increasingly in obstetric practice over the past decade. To date, adverse effects of ultrasound on the fetus have not been reported, but studies have been done on small sample sizes. This study looks specifically at the association of ultrasound exposure during pregnancy and the risk of low birthweight in the offspring. A validation case-control study was also performed based on information from a sample of medical charts. With a database of more than 13,000 pregnancies, there was no indication of an adverse effect of ultrasound performed during the first two trimesters of pregnancy.

Adolescent↗
PubMed1994

Characteristics of Vagococcus salmoninarum isolated from diseased salmonid fish.

Isolates of the salmonid pathogen Vagococcus salmoninarum were recovered from Atlantic salmon, rainbow trout and brown trout with peritonitis. The phenotypes of these isolates and the type strain of Vag. salmoninarum NCFB 2777 were determined by morphological, biochemical and physiological tests and whole cell protein profiles by SDS-PAGE. There was a high level of phenetic similarity between the salmonid isolates and the type strain. The species forms short Gram-positive rods, hydrolyses L-pyrrolidonyl-beta-naphthylamide, is alpha-haemolytic on sheep's blood agar, grows at pH 9.6 and 10 degrees C but not at 40 degrees C or in 6.5% NaCl and is catalase-negative; a Lancefield group N antigen is not present. Vagococcus salmoninarum can be distinguished phenetically from similar fish pathogens including Carnobacterium piscicola, Enterococcus seriolicida and Lactococcus piscium.

Animals↗
PubMed1994

Occupational stress amongst care staff working in nursing homes: an empirical investigation.

A questionnaire survey of care staff in nursing homes examined staff stress. Staff completed questionnaires covering Type A behaviour, job satisfaction, psychological well-being, relaxation behaviour, coping skills and demographic details. A specific measure of nursing home stress was developed following a pilot study. From a total sample of 375, 112 (30%) responses were obtained. On the stress questionnaire the major stressors were found to be 'unsatisfactory wages', 'shortage of essential resources', 'not enough staff per shift', 'feeling undervalued by management', 'lifting heavy patients' and 'working with colleagues who are happy to let others do the work'. Factor analysis of stress questionnaire responses identified five major stress groupings. These were, 'differing expectations about patient care', 'management factors', 'lack of support from other staff', 'feeling inadequately trained to deal with job demands' and 'home-work conflicts'. Examination of stress outcomes showed that many staff were under pressure, with high levels of smoking and alcohol intake. Given the increasing importance of nursing home care for the elderly the present study is timely. The implications of the findings for further research, and for the training of staff in nursing homes are considered.

Adult↗
PubMed1994

Forging a future for nursing. A system's nurse executives collaborate to create a strategic plan.

In early 1991 the Nurse Executives' Council (NEC) of the Seattle-based Sisters of Providence Health System completed a survey assessing the effectiveness of patient care delivery processes and gauging the extent to which nurses participate in planning programs and services. Later that spring the NEC reviewed the survey and made a preliminary identification of nursing strategic issues. To complement this internal survey, in fall 1991 the council was given an overview of the external environment as it relates to nursing. The council also formed three committees--Strategic Planning/Bylaws, Human Resources, and Productivity--to address concerns that surfaced in the internal assessment survey process and to help design a document outlining the council's strategic plan for system nurses. After working with the NEC liaison, the Strategic Planning/Bylaws Committee drafted a plan for review by NEC members before submitting it for approval by appropriate bodies within the organization. The final plan, unveiled at the fall 1992 NEC meeting, identifies four key strategic issues for nursing, including the need to: Develop nursing leadership; Maximize human resources; Coordinate client and patient care over a continuum of healthcare services; Demonstrate fiscal stewardship.

Decision Making, Organizational↗
PubMed1993

Transfusion and surgery.

In this survey of transfusion in surgery, we have attempted to provide the surgeon with an understanding of the problems associated with homologous transfusion and a practical knowledge of treatment strategies and alternatives designed to reduce homologous blood exposure. Such a review cannot be encyclopedic. Our hope is that it will serve the reader as a stimulus to examine his or her transfusion practices and as a guide for future self-learning.

Animals↗