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Biomedical subjects

M Johnson

Publications and source records attributed to M Johnson.

At least 397 records · Page 22Linked to original sources
PubMed1995

The power of social judgement: struggle and negotiation in the nursing process.

In this paper we discuss an alternative view of the nursing process as it is experienced by both patients and nurses. The current conception of the nursing process is that it is a benevolent activity which aims to render care more individualized or person-centred. Its rhetoric usually includes notions of mutuality in goal setting, openness and collaboration between patients and nurses. We will suggest that such a view is idealized and has little basis in empirical reality as it is experienced by both nurses and patients. Rather, nurse-patient relations are beset by conflict and struggle, frequently resulting in the acquiescence of patients to the nursing and the medical goals of care. On the basis of an ethnography of a hospital medical ward, we will describe a process of social judgement and set it into a discussion of the social context where an unequal balance of power is integral to provider-recipient relations. Our account will focus upon four categories through which judgemental labelling may be analysed. These are assessing, negotiation, struggling and acquiescing. Of special interest to us are strategies which nurses used to maintain excellent care in the context of negative social judgements, and the place social judgement may play in moral decision-making. We emphasize the strengths which rich qualitative data have in relation to previous survey approaches of this phenomenon, whilst recognising the limitations of so focused a study.

Humans↗
PubMed1995

Essential thrombocytosis: underemphasized cause of large-vessel thrombosis.

PURPOSE: The purpose of this study was to describe the clinical course of patients seen with large-vessel thrombosis in association with essential thrombocytosis (ET). METHODS: This study was a retrospective review of all patients treated for large-vessel thrombosis caused by ET during a 2-year period at University of Washington teaching hospitals. RESULTS: Five patients presented with arterial (femoral-popliteal-tibial: aortic), portal (two cases), or systemic venous (inferior vena cava) thrombosis and required operation. Two were known to have ET; in three others ET was diagnosed after operation when platelet counts persistently in excess of 500,000/mm3 were noted. The diagnosis of ET was established in each case by ruling out causes of reactive thrombocytosis and (in the three new cases) by evidence for megakaryocyte hyperplasia on bone marrow biopsy. Platelet counts in all five patients were reduced to normal levels by cytoreductive therapy, and no further thrombotic episodes have occurred during 18 months (mean) of follow-up. During this 2-year period ET accounted for more large-vessel thrombotic complications in our institutions than all other more frequently described hypercoagulable states combined. CONCLUSIONS: ET is an underemphasized cause of large-vessel thrombosis.

Adult↗
PubMed1995

Face processing impairments after amygdalotomy.

We report an investigation of face processing impairments in D.R., a 51-year-old woman with a partial bilateral amygdalotomy. D.R. was able to recognize pre-operatively familiar faces, but she showed generalized problems of name retrieval and a more circumscribed deficit affecting the recognition of faces learnt post-operatively. In contrast to her poor memory for new faces, D.R.'s ability to match simultaneously presented photographs of unfamiliar faces was unimpaired. However, D.R. also experienced deficits in expression processing which compromised the recognition of emotion from people's faces: she was poor both at matching and at identifying photographs of emotional facial expressions. In addition, her interpretation of eye gaze direction was defective, showing a more general problem in reading social signals from the face. The presence of impairments affecting the learning of new faces and the comprehension of gaze direction and facial expressions of emotion is consistent with the hypothesis of a role for the amygdala in learning and social behaviour.

Amygdala↗
PubMed1995

Maternal plasma concentrations of insulin-like growth factor binding protein-1 and placental protein 14 in multifetal pregnancies before and after fetal reduction.

The aim of this study was to investigate the changes in maternal plasma insulin-like growth factor binding protein-1 (IGFBP-1) and placental protein 14 (PP14) in multifetal pregnancies before and after embryo reduction. Maternal plasma IGFBP-1 and PP14 were measured serially in three groups of pregnant women at 8-21 weeks gestation. Groups 1 and 2 were 12 singleton and 12 twin pregnancies achieved after in-vitro fertilization (IVF). Group 3 comprised 26 women with multifetal pregnancies undergoing embryo reduction to twins. In the IVF pregnancies maternal plasma IGFBP-1 and PP14 increased with gestation to reach a peak at 20 and 10 weeks respectively; the mean concentrations in twin pregnancies were significantly higher than in singletons. In multifetal pregnancies the mean plasma concentration of both proteins was similar to that of IVF twin pregnancies before reduction; after reduction, the values fell to less than those of twins. These findings suggest that the maximum secretory capacity of the endometrium is achieved with twin pregnancies. In multifetal pregnancies undergoing iatrogenic reduction to twins, total residual endometrial function was less than in twin conceptions.

Carrier Proteins↗
PubMed1995

First-line nurse managers in rural hospitals: perceptions of career success.

First-line nurse managers in small rural hospitals are essential to organizational survival, yet little is known about such individuals. A pilot study comparing demographic characteristics and career success perceptions of first-line nurse managers from rural settings with doctorally prepared nurses found that despite age and educational differences, personal characteristics identified as contributing to career success were remarkably similar in both groups. First-line nurse managers generally credited family members with greater degrees of career influence than did their more educated colleagues. However, both groups saw themselves as primarily responsible for their own career success. This information may assist rural hospitals and nursing personnel to enhance their strategic position in the unstable environment of health care reform.

Adult↗
PubMed1995

Rediscovering unpopular patients: the concept of social judgement.

Nurses have known about unpopular patients for over two decades. Influential studies such as Stockwell's in the UK have had considerable impact upon students of nursing. Stockwell's book, The Unpopular Patient, is widely cited and was reprinted in 1984. Further, a critical review of the wider literature by Kelly & May threw down a challenge to researchers to investigate the phenomenon using an interactionist perspective and ethnographic methods. This paper reports a study which should begin to reinforce doubt that evaluative labels, unpopular or otherwise, are in any way 'predictable', as Stockwell and a host of others have hoped and assumed. The process through which evaluative labels of people are socially constructed is explored and the context, explanations and some consequences of what we call social judgement are discussed.

Adult↗
PubMed1995

The anti-inflammatory profile of fluticasone propionate.

Fluticasone propionate is a new corticosteroid based on the androstane nucleus. It is more lipophilic than beclomethasone dipropionate (BDP) and budesonide, and binds more avidly to human lung tissue. It has an absolute affinity (KD) of 0.5 nM for the glucocorticoid receptor and a relative receptor affinity 1.5- and 3.0-times greater than that of beclomethasone-17-monopropionate (17-BMP) and budesonide, respectively. The rate of association with the receptor is faster and the rate of dissociation slower than with standard corticosteroids. As a result, the half-life of the corticosteroid-receptor complex is > 10 h. Fluticasone propionate is also highly selective for the glucocorticoid receptor, with little or no activity at other steroid receptors. Pretreatment with fluticasone propionate significantly inhibits the increase in mast cell numbers in the nasal mucosa of rats chronically exposed to toluene di-isocyanate (TDI), and suppresses TDI-induced mast cell degranulation. It is more potent in vitro than dexamethasone, BDP and budesonide in inhibiting anti-CD3-induced human T-lymphocyte proliferation, in attenuating tumour necrosis factor-alpha-induced endothelial cell adhesion molecule expression, and in increasing secretory leucocyte protease inhibitor levels in airway epithelial cells. It is also more potent and longer-acting than other corticosteroids in inhibiting oedema formation, interleukin-5 (IL-5)-induced blood eosinophilia, and IL-5- or platelet activating factor-stimulated eosinophil accumulation in the lung. Fluticasone propionate therefore has increased intrinsic glucocorticoid potency and high topical anti-inflammatory activity.

Administration, Topical↗
PubMed1995

The prevalence of leg ulcers in older people: implications for community nursing.

The prevalence of chronic leg ulcers has been investigated in older people living in the community. This condition has a low prevalence, but major health costs are associated with frequent home nursing visits, community nursing services being the main providers of care. An estimate was made of the prevalence of chronic leg ulcers in a cross-sectional random sample of noninstitutionalized older people living in a major Australian city (N = 1,050). The prevalence estimate is compatible with estimates of 1% in the over-60 age group found in Swedish and Northern American studies. Age-adjusted gender ratios demonstrate slightly higher prevalence in females than males (1.25:1). Implications for community nursing services for primary, secondary, and tertiary prevention are outlined and include education programs for seniors dispelling myths that leg ulcers are a natural part of aging, screening for venous and arterial peripheral vascular disease in the older community, collaborative nurse and podiatrist foot care clinics, and the location of leg ulcer clinics in geriatric day care centers.

Age Distribution↗
PubMed1995

Hypothermia reversibly inhibits endothelial cell expression of E-selectin and tissue factor.

Hypothermia frequently accompanies cardiopulmonary bypass (CPB) and myocardial protection strategies during cardiac surgery. With CPB, the blood/artificial surface interface activates components of the humoral and cellular inflammatory cascades and may contribute to postoperative end organ dysfunction including the heart or multiple other organ systems. The endothelial cell (EC) monolayer normally mediates components of solute transport, vasomotor function, coagulation, cell differentiation/growth, and immune/inflammatory processes. E-selectin is a vascular adhesion molecule that mediates neutrophil adherence and that is inducible in ECs by inflammatory mediators such as cytokines. Tissue factor (TF) is similarly an inducible procoagulant factor in ECs that contributes to thrombosis. The induction, transcription, and expression of both molecules were studied in cultured human umbilical vein cells at normothermic (37 degrees), hypothermic (25 degrees), and rewarmed (37 degrees) conditions after stimulation with the cytokines tumor necrosis factor alpha and interleukin-1. Hypothermia reversibly inhibits the transcription and expression but not the induction of both E-selectin and TF.

E-Selectin↗
PubMed1995

Body dysmorphic disorder in patients with anxiety disorders and major depression: a comorbidity study.

OBJECTIVE: The authors evaluated the frequency of body dysmorphic disorder in patients with a primary diagnosis of anxiety disorders and major depression. METHOD: Patients with social phobia (N = 54), obsessive-compulsive disorder (N = 53), generalized anxiety disorder (N = 32), panic disorder (N = 47), and major depression (N = 42) and normal comparison subjects (N = 33) were studied. RESULTS: Body dysmorphic disorder was most common in patients with social phobia (11%) and obsessive-compulsive disorder (8%); it was less prevalent among patients with panic disorder (2%), generalized anxiety disorder (0%), and major depression (0%) and among normal subjects (0%). CONCLUSIONS: These findings suggest that body dysmorphic disorder may share etiologic elements with social phobia and obsessive-compulsive disorder.

Adolescent↗
PubMed1995

The library as a resource for decision making in mental health care.

OBJECTIVE: The study sought to determine whether mental health practitioners decided to make changes in specific areas of patient or client care as a result of information obtained from library literature searches. METHODS: A ten-question survey was distributed to 350 mental health professionals who had requested at least one computerized literature search from a library affiliated with a state institute of mental health during an eight-month period. RESULTS: A total of 70.5 percent of survey respondents made one or more changes in their approach to patient or client care after reviewing the information obtained through the search. CONCLUSIONS: Access to the wide range of research and experience embodied in the published literature is a valuable adjunct to the mental health professional's training and personal experience.

Attitude of Health Personnel↗
PubMed1995

Diagnosis and hospital readmission rates of female veterans with substance-related disorders.

OBJECTIVES: The study examined the prevalence of substance use, psychiatric, and medical disorders in female veterans discharged from VA hospitals. METHODS: The VA discharge abstract database was used to identify women discharged in fiscal year 1991 who received a diagnosis of substance abuse or dependence or substance-induced psychosis (N = 1,698). They were compared with female veterans who did not receive a substance-related diagnosis (N = 12,037). RESULTS: Alcohol and cocaine use disorders were the most prevalent substance use disorders. Women with substance use disorders were more frequently diagnosed as having personality disorders, depression, and posttraumatic stress disorder than women without substance use disorders. Skin and subcutaneous tissue diseases, infectious and parasitic diseases, and digestive diseases were more prevalent among women with substance use disorders than among women in the same age group who did not have substance use disorders. Approximately 44 percent of women with substance use disorders who were discharged during the first six months of fiscal year 1991 were rehospitalized within that year. CONCLUSIONS: Substance use disorders and associated comorbidities are endemic among women treated in VA hospitals. Additional studies examining characteristics of indigent women with substance use disorders are needed.

Adult↗
PubMed1995

Variables that predict interest in and the completion of living wills.

Observes that although chaplains and congregational pastors frequently advocate the completion of advance directives, including living wills, the research reports that only 5 to 15% of the general population have completed the instrument. Asks, Why have so few completed it? Reports on research which suggests that age is the only statistical predictor of whether a person possesses a completed living will when measured against social and personality variables, including levels of social support, fear of dying, religiousity, self-esteem, and trust in physicians. Concludes that it is likely that age is a proxy variable which represents changes in attitudes, beliefs, and thoughts which tend to occur as persons grow older.

Advance Directives↗
PubMed1995

Patient characteristics and environmental factors in leg ulcer healing.

This study examined the effects of patient characteristics and environmental factors on the healing of leg ulcers in older people living in the community. A descriptive comparative design was used to examine factors such as age, gender, socio-economic status, cognition, smoking, ulcer duration, certain diseases and medication. Only socio-economic status was found to influence healing: patients from lower socio-economic classes were more likely to be non-healers. Recommendations on factors to consider in sampling criteria and research design in experimental studies are also discussed.

Aged↗
PubMed1995

Interactional aspects of self-efficacy and control in older people with leg ulcers.

1. Interventions that increase the sense of self-efficacy or competence of the client may have positive health outcomes. 2. Health professional (powerful other) interaction is proposed to have beneficial effects upon health beliefs and health outcomes in the elderly with chronic disease. 3. Beliefs about the ability to perform the required behavior (self-efficacy) are associated with beliefs about a positive health outcome being contingent upon behavior performance (response efficacy).

Aged↗
PubMed1995

Hepatocyte growth factor-induced signal transduction in two normal mouse epithelial cell lines.

We have investigated HGF-induced signal transduction in two normal mouse epithelial cell lines (M23 and MM55). Both cell lines display HGF-induced mitogenesis and high level HGF-induced autophosphorylation of MET/HGFR. In both M23 and MM55 cells, HGF induces association with MET/HGFR and increased tyrosine phosphorylation of the SH2-domain containing proteins PI3K, GAP and NCK. PLC-gamma exhibited neither HGF-induced increases in tyrosine phosphorylation nor an association with MET/HGFR in these cell lines. Additionally, HGF induced increased transcription of c-fos, c-jun, junB, junD, and c-myc early response genes in both cell lines. We therefore suggest that the second messenger proteins PI3K, GAP and NCK, and possibly the protein products of the c-fos, c-jun, junB, junD and c-myc genes, are important elements in the HGF-induced mitogenic pathway in the normal mouse epithelial cell lines M23 and MM55.

Animals↗