Search PubMed⌕ Search

Biomedical subjects

J Crisp

Publications and source records attributed to J Crisp.

At least 19 recordsLinked to original sources
PubMed2007

Perceptions of veterinarians and clients to expressions of clinical uncertainty.

OBJECTIVES: The aim of this study was to explore the attitudes of veterinarians and clients towards expressions of clinical uncertainty. METHODS: Questionnaires that assessed the respondent's attitudes towards expressions of clinical uncertainty were completed by clients at six small animal practices. In addition, questionnaires that evaluated what veterinarians thought their client's attitudes would be towards expressions of clinical uncertainty were completed by veterinarians. The responses from clients and veterinarians were statistically compared. RESULTS: Veterinarians significantly underestimated the desire of clients to be told about uncertainties in treatment and significantly overestimated how the expression of uncertainty would generally reduce client confidence. Veterinarians significantly overestimated the loss of client confidence resulting from saying "I am not sure about this" and from asking a nurse for advice. Both clients and veterinarians considered that verbal expressions of uncertainty would lead to a greater reduction in client confidence than behavioural expressions of uncertainty. CLINICAL SIGNIFICANCE: This study suggests that most clients want to be told about their veterinarian's clinical uncertainties, and how this uncertainty is expressed can markedly influence client confidence.

Attitude of Health Personnel↗
PubMed2005

Thermo-expandable intra-prostatic stent in the treatment of acute urinary retention in elderly patients with significant co-morbidities.

We assess the use of thermo-expandable intra-prostatic stent (Memokath, Engineers and Doctors A/S, Denmark) for the treatment of acute urinary retention (AUR) in men with significant co-morbidities for transurethral resection of prostate (TURP). We evaluate the pre- and post-operative complications, duration of stents in-situ and patients quality of life after the stent insertion. Patients with significant co-morbidities presenting with AUR were selected, who were unfit for TURP. The co-morbidities included ischaemic heart disease, congestive heart failure, and chronic obstructive pulmonary disease. The exclusion criteria were bladder tumour and atonic bladder. The Memokath stents were inserted using a flexible cystoscope under local anaesthesia. The patients were followed up at 3 and 6 months after the procedure and the ones who remained alive were asked to complete self-administered questionnaires and IPSS scores. Fifteen men with acute urinary retention were recruited for stent insertion with the mean age of 87 years. No peri-operative complications were recorded. Three patients died after the insertion with functional Memokath in-situ. Nine patients had good functioning stents post-operatively, and remain catheter free up to 30 months after the procedure. The mean duration of stent life was 18 months. Three long-term complications were detected, including stent migration and prostate overgrowth. The Memokath is a good option for frail elderly patients presenting with AUR. The procedure is safe and has minimal long term complications. The stent also provides a sustained good quality of life for patients and avoids the necessity of long term catheterisation.

Acute Disease↗
PubMed2003

Adherence issues in children and adolescents receiving highly active antiretroviral therapy.

The introduction of highly active antiretroviral therapies (HAART) for the treatment of paediatric HIV infection poses additional adherence challenges for children and families living with HIV A preliminary survey of 18 parents of children receiving HAART in Australia showed that although parents report high level of child adherence to HAART, specific features of the medication regimen, such as taste and number of medications made administration of HAART extremely difficult.Moreover, interaction between the treatment regimen and the day-to-day lives of families increases the adherence challenge. While some agreement exists in relation to the concerns families have about negative aspects of HAART; the diversity of issues suggests the need for ongoing and individualized support and information to families.

Adolescent↗
PubMed2000

Compartmental pharmacokinetics and tissue distribution of multilamellar liposomal nystatin in rabbits.

The plasma pharmacokinetics of multilamellar liposomal nystatin were studied in normal, catheterized rabbits after single and multiple daily intravenous administration of dosages of 2, 4, and 6 mg/kg of body weight, and drug levels in tissues were assessed after multiple dosing. Concentrations of liposomal nystatin were measured as those of nystatin by a validated high-performance liquid chromatography method, and plasma concentration data were fitted into a two-compartment open model. Across the investigated dosage range, liposomal nystatin demonstrated nonlinear kinetics with more than proportional increases in the AUC(0-24) and decreasing clearance, consistent with dose-dependent tissue distribution and/or a dose-dependent elimination process. After single-dose administration, the mean C(max) increased from 13.07 microg/ml at 2 mg/kg to 41.91 microg/ml at 6 mg/kg (P < 0.001); the AUC(0-24) changed from 11.65 to 67.44 microg. h/ml (P < 0.001), the V(d) changed from 0.205 to 0. 184 liters/kg (not significant), the CL(t) from 0.173 to 0.101 liters/kg. h (P < 0.05), and terminal half-life from 0.96 to 1.51 h (P < 0.05). There were no significant changes in pharmacokinetic parameters after multiple dosing over 14 days. Assessment of tissue concentrations of nystatin near peak plasma levels after multiple dosing over 15 days revealed preferential distribution to the lungs, liver, and spleen at that time point. Substantial levels were also found in the urine, raising the possibility that renal excretion may play a significant role in drug elimination. Liposomal nystatin administered to rabbits was well tolerated and displayed nonlinear pharmacokinetics, potentially therapeutic peak plasma concentrations, and substantial penetration into tissues. Pharmacokinetic parameters were very similar to those observed in patients, thus validating results derived from infection models in the rabbit and allowing inferences to be made about the treatment of invasive fungal infections in humans.

Animals↗
PubMed1998

Australian nurses and device use: the ideal and the real in clinical practice.

Clinical nurses use an increasing number of technological devices when providing care. While the clinical devices themselves must undergo rigorous multidimensional assessment, it is the proficiency of the user that ultimately determines the devices' efficacy. Thus, the knowledge, skills and attitudes that nurses bring to their decision-making and use of technology are crucial elements in the technology assessment process. Technological proficiency is imperative in the current climate of rapid patient throughput in complex technological environments. This paper reports some of the findings of an Australian study, using two national Delphi panels, whose primary objective was to determine the knowledge, skills and attitudes required of expert clinicians for practice in cardiac care. Panels of 28 educators and 42 cardiac nurse clinicians completed a questionnaire indicating the importance of 107 characteristics of expert cardiac practice for both the 'real' and 'ideal' worlds of practice. Comparative results will be reported for 29 items within the thematic groups. Effective use of technology, Informed decisions regarding equipment and Critical approach to the use of technology. Both panels accepted all 29 items in these three thematic groups but indicated differences in the level of agreement on the importance of items between the 'real' and 'ideal' worlds of practice. Discussion centres around those areas where improvement is needed.

Australia↗
PubMed1997

The chemical composition of Martian soil and rocks returned by the mobile alpha proton X-ray spectrometer: preliminary results from the X-ray mode.

The alpha proton x-ray spectrometer (APXS) on board the rover of the Mars Pathfinder mission measured the chemical composition of six soils and five rocks at the Ares Vallis landing site. The soil analyses show similarity to those determined by the Viking missions. The analyzed rocks were partially covered by dust but otherwise compositionally similar to each other. They are unexpectedly high in silica and potassium, but low in magnesium compared to martian soils and martian meteorites. The analyzed rocks are similar in composition to terrestrial andesites and close to the mean composition of Earth's crust. Addition of a mafic component and reaction products of volcanic gases to the local rock material is necessary to explain the soil composition.

Aluminum↗
PubMed1997

Determining and discerning expert practice: a review of the literature.

Although the nature and characteristics of expert practice have been described in the literature, the description is incomplete. How expertise is gained is not fully understood, and definitions of expert competencies have yet to be developed. Essential issues for education arise from the demand for knowledge for expert practice. Because expertise is gained in the context of practice, expertise cannot be achieved out of context or taught as an academic exercise. A clear picture of the practice of expert nurses is necessary so that those in the profession can know and articulate expert practice and direct it to the community.

Clinical Competence↗
PubMed1997

The cardiac nurse's role: an Australian Delphi study perspective.

In Australia, as in many parts of the Western world, technological advances in healthcare have affected the roles of healthcare professionals, including nurses. Cost constraints, efficiency, and effectiveness measures also influence staffing numbers, roles, and skill mix. Specialty nurse education programs are changing, and many are moving from the hospital environment to the higher education sector. Initiatives to introduce the American Advanced Nurse Practitioner role in some environments have begun, although the current advanced practice roles are proving problematic. Specialist professional groups are striving to develop competencies or standards for practice. An understanding of what is required of expert clinicians for practice in complex technological environments such as cardiac care would be useful for both practitioners and academics. A national Delphi study was undertaken to determine what knowledge, skills, and attitudes were required of expert cardiac nurses in relation to technology in the cardiac care environments in both the "real" and the "ideal" worlds of practice. Separate panels of 28 cardiac educators and 42 cardiac nurse clinicians were given a questionnaire of 107 items and asked to indicate on a 6-point Likert scale the importance of each item to the nursing roles in both the "real" and "ideal" worlds. On the final, third round, respondents ranked the three most important items in each of the 13 thematic groups. Overall, the clinicians accepted all 107 items as important to their role, and for the majority of these they, felt that they were performing quite close to their "ideal." This article presents the 32 items for which the clinicians felt the "real" world was quite far from the "ideal" as represented by a gap of > or = 2 between the real and ideal medians. Also, despite being accepted as part of the role through the ideal scores, 21 items achieved a real world median of 3.5 or less, which indicates that in the real world these aspects of nursing are not being valued or practiced to the level clinicians would like. These two sets of items should be of greatest interest to clinicians currently in the role and to those interested in specialty education at all levels.

Australia↗
PubMed1997

Publishing workshops number 4. Preparing a manuscript: reviewing literature.

In this paper we have looked at the different avenues for nurses to contribute to the knowledge base of the discipline by writing about nursing literature. We emphasised the responsibility that goes with this action. As with all writing the starting point is for the author to define the boundaries of the work, and then decide what it is that she or he wants to communicate. After that it is a matter of planning a logical and coherent sequence and proceeding to develop the content in language that is as simple and effective as possible. Reference was made to the general guidelines for writing proposed in an earlier workshop (Chick et al, 1996). In this paper three different forms, a review article, a literature review and review of a piece of literature have been discussed, noting the purposes that each serves and the way in which, to a large extent, purpose dictates both content and the order and priority to be given to the various sections. Three of the key dimensions along which variation can occur are scope, critical emphasis, and relevance to practice.

Humans↗
PubMed1996

The impact of the technological care environment on the nursing role.

Proliferation of acute health care technology creates problems and benefits for nurses and patients. In this paper the impact of technology on the nursing work role is reviewed through the international literature. The thrust of the nursing literature has, not surprisingly, matured over time as the use of technology has become well established in the acute care environment, and three themes can be identified. The implications for acute care nurse specialists, including their educational needs, are set in context of the Australian health care system, with particular reference to the cardiac care environments.

Australia↗
PubMed1996

The impact of experience on children's understanding of illness.

Reported two studies investigating the relationship between the extent of children's experience with illness and their level of understanding about the causes of illness. Both studies compared children with experience of a major chronic illness (cystic fibrosis in Study 1 and cancer in Study 2) with children whose illness experience was relatively minor and acute. The age range of the children in Study 1 was 4.6 to 10.6 years; in Study 2 it was 7 to 14 years. The measure of understanding of illness was the Bibace and Walsh (1980, 1981) Piagetian-based test. To determine the specificity of illness experience effects, performance on this test was considered against a second measure of cognitive functioning: conservation of amount and volume in Study 1; the Peabody Picture Vocabulary test-Revised in Study 2. Results point to both age and experience as contributing to children's understanding of illness. Methodological issues and implications for future research are discussed.

Acute Disease↗