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Biomedical subjects

J Currey

Publications and source records attributed to J Currey.

11 recordsLinked to original sources
PubMed2001

Making decisions: nursing practices in critical care.

This article reports the types and complexity level of decisions made in everyday clinical practice by critical care nurses. It also reports factors that influence the complexity of those decisions. A combination of methods were chosen for the two phase study. In the first phase, 12 qualified critical care nurses documented decisions (over a 2 hour period) on a clinical decision recording form designed by the researcher. In the second phase, participants attended a semi-structured focus group. From the analysis, five types of decisions were identified; assessment, intervention, organisation, communication and education. In addition to these documented decisions, three factors that influenced decision complexity were identified from a thematic analysis of the transcribed interviews; communication, patient related and properties of the decision. Nurses reported that communication decisions were the most difficult to make. However, the concept of nurses knowing the patient reduced the level of decision complexity. It is suggested that this has important implications for decision making practices of nurses working in the area of critical care and potentially for patient outcomes.

Communication↗
PubMed1997

Endogenous nitric oxide and low systemic vascular resistance after cardiopulmonary bypass.

OBJECTIVES: To investigate the relationship between excessive endogenous production of nitric oxide (NO) and the low systemic vascular resistance (SVR) syndrome after cardiac surgery. DESIGN: Prospective, case-control. Cases defined by low SVR postoperatively (< 750 dyn/s/cm-5), and matched with controls (> 900 dyn/s/cm-5). SETTING: Cardiothoracic intensive care unit (ICU) in a tertiary care hospital. PARTICIPANTS: Forty-four patients after cardiac surgery. INTERVENTIONS: Collection of plasma and urine samples after identification. MEASUREMENTS AND MAIN RESULTS: Plasma and urine nitrate concentrations were measured as an index of endogenous NO production. Hemodynamic, inotropic, and outcome data were collected. Median nitrate concentrations did not differ between cases and controls (plasma, 58 mumol/L, v 62 mumol/L, p = 0.43; urine, 399 mumol/L v 404 mumol/L, p = 0.38). Times to extubation and intensive care unit (ICU) discharge were prolonged in patients with low SVR (17.8 hours v 8.7 hours, p = 0.021; 2.5 days v 1.2 days, p = 0.019, respectively). CONCLUSIONS: No association between "low SVR syndrome" and endogenous NO production was found. Patients with low SVR after cardiac surgery required a longer period of inotropic and ventilator support, with delay in discharge from the ICU. The risk and cost implications of this syndrome support further research.

Adult↗
PubMed1997

Scalp necrosis in giant cell arteritis and review of the literature.

A patient with giant cell arteritis (GCA) who developed scalp necrosis (SN) is described and 23 other cases in the English language literature are reviewed. SN is rare and occurs in older patients of mean age 77 yr. Thirteen patients presented to dermatologists. Nineteen (79%) had other serious complications of GCA: visual loss in 16, gangrene of the tongue in four and nasal septum necrosis in one. The mean interval between the onset of symptoms of GCA and SN was 3.0 months in the 19 cases which antedated corticosteroid therapy. SN resulted from active arteritis and no case was definitely linked to temporal artery biopsy. Scalp healing was complete or progressing satisfactorily in 18 cases (75%). SN is a potentially reversible complication of GCA and adequate corticosteroid therapy is mandatory. In the current case. SN related to inadequate dosage of prednisolone.

Aged↗
PubMed1987

Danesbury--changing patterns in the care of the younger disabled over three decades.

The pattern of care in a subregional Younger Disabled Unit (YDU) over three decades is described. The trend is now towards planned short-stay admissions, but the need for some long-stay beds remains. A survey of one district with a total population of 287,600 found 165 patients aged 18-65 with significant disability. It is suggested that there are four main categories within the younger disabled group whose requirements range from independent living to special units run by psychiatrists. The YDU is an important focal point for information on all aspects of disability.

Adolescent↗