PubMed Health⌕ Search

Biomedical subjects

Linda Johnston

Publications and source records attributed to Linda Johnston.

At least 19 recordsLinked to original sources
PubMed2006

Skin conductance as a measure of pain and stress in hospitalised infants.

BACKGROUND: Reliable and valid methods of measuring pain responses in infants continue to be sought as a means of evaluating the effectiveness of pain reduction strategies. Skin conductance has recently been shown to be a promising physiological indicator of pain and stress in premature and term infants. AIM: To evaluate changes in skin conductance in hospitalised infants under different environmental conditions and during both painful and non-painful procedures. METHODS: Measurements of skin conductance activity were made in infants under three different environmental temperature conditions (open cot, incubator and overhead radiant heater), during the routine non-painful nursing procedure of either nappy change or oral feeding, and whilst undergoing the painful procedure of heel lancing for blood sampling. RESULTS: Skin conductance activity in 21 infants was studied on 43 separate occasions. Skin conductance activity was highly variable between infants but did not differ significantly under the three environmental conditions. Routine nursing care did not result in a significant increase in skin conductance activity above baseline; however, on cessation of care there was a significant reduction to levels below baseline (p < 0.05). Conversely, during the heel lance procedure, skin conductance activity significantly increased upon lance (p < 0.05) and remained elevated following completion of the procedure. There were no statistically significant differences between skin conductance activity changes from baseline as a result of routine nursing care compared to that of the heel lance procedure. CONCLUSION: Due to large variability in skin conductance activity further studies are needed before this technology can be recommended as a clinically useful indicator of pain and stress in neonates.

Galvanic Skin Response↗
PubMed2006

Beyond the BARRIERS Scale: commonly reported barriers to research use.

The evidence-based practice movement has highlighted the importance of translating research evidence into practice. However, the gap between research and practice points to the existence of significant barriers to research use. To identify the most commonly cited barriers to the use of research in practice, the findings arising from studies that used the Barriers to Research Utilization Scale are examined. Based on these findings, the authors discuss and make recommendations to assist nurse administrators in overcoming universally reported barriers to research use.

Attitude of Health Personnel↗
PubMed2005

Home INR monitoring of oral anticoagulant therapy in children using the CoaguChek S point-of-care monitor and a robust education program.

INTRODUCTION: Management strategies such as self-monitoring of anticoagulant therapy have been reported with increased frequency. Whilst patient education is frequently mentioned, details regarding the educational interventions employed are scarce. This study aimed to improve the outcomes of home monitoring of warfarin therapy in children through the development and implementation of a robust intervention, based upon the PRECEDE model of education. MATERIALS AND METHODS: Participating parents had to complete an intensive education and training program. After demonstrating practical and theoretical competency, parents commenced home monitoring. Every second scheduled home INR (H-INR) required a paired INR on the same day, obtained by a trained pathology collector (C-INR). Demographic and statistical outcome data was collected. RESULTS: Parental understanding of warfarin therapy improved significantly following the educational intervention (p<0.0001). 65.5% of H-INRs and 64.4% of C-INRs were within the target range (ns). Lin's correlation coefficient between H-INRs and C-INRs was 0.949. There were no warfarin-related adverse events. CONCLUSION: This study demonstrated a significant improvement in parental knowledge following participation in a robust educational intervention. Furthermore, compared to previous reports in children, a greater level of correlation between home and hospital-based INRs was achieved by participating parents. The use of similar educational interventions may serve to improve the outcomes of similar management strategies.

Administration, Oral↗
PubMed2005

Polymerization of the SAM domain of MAPKKK Ste11 from the budding yeast: implications for efficient signaling through the MAPK cascades.

The sterile alpha-motif (SAM) is a protein module approximately 70 residues long and mainly involved in the protein-protein interactions of cell signaling and transcriptional repression. The SAM domain of the yeast MAPKKK Ste11 has a well-folded dimeric structure in solution. Interestingly, the well-folded dimer of the Ste11 SAM undergoes a time-dependent self-assembly upon lowering of the pH, leading to the formation of high molecular weight oligomers. The oligomeric structures rapidly disassemble to the well-folded dimer upon reversal of the pH to close to neutral conditions. Circular dichroism (CD) and atomic force microscopy (AFM) experiments demonstrate that the oligomeric structure formed at pH 5.0 appears to be highly helical and has architecture akin to proto-fibrils. Residue-specific kinetics of pH-triggered oligomerization obtained from real-time 15N-1H HSQC experiments indicate that the dimer-oligomer transition appears to involve all residues of the well-folded dimeric structure of the Ste11 SAM. Very interestingly, the interactions of the Ste11 and Ste50 SAM domains also lead to the formation of non-homogeneous hetero-complexes with significant populations of high molecular weight aggregates. AFM imaging shows that the Ste11-Ste50 hetero-polymeric aggregates assume the shapes of circular nano-particles with dimensions of 50-60 nano-meters (nm), in contrast to the proto-fibrils formed by the Ste11 SAM domain alone. Such intrinsic propensity for dimer to oligomer transition of the Ste50-binding SAM domain of Ste11 may endow the MAPKKK Ste11 with unique functional properties required for efficient and high fidelity signal transduction in the budding yeast.

Circular Dichroism↗
PubMed2005

Patient understanding of warfarin therapy: a review of education strategies.

Significant research has been directed into defining best-practice anticoagulant management of thromboembolic events and optimal strategies for determining the safety and efficacy of therapy. Similarly, improved patient outcomes have been realised through the development of novel management strategies such as self-monitoring and self-management. Considerably, less energy has been directed towards developing and evaluating the best mechanisms for delivery of patient education. This is in spite of the fact that numerous confounders to stable therapy confront warfarinised patients on a daily basis. That patients requiring warfarin therapy should be educated with respect to that therapy has never been questioned. However, relatively little attention appears to have been paid to the development of robust models of patient education in the setting of oral anticoagulant therapy. This paper reviews the current literature with respect to warfarin education interventions before recommending strategies that may facilitate determination of the impact educating patients about warfarin therapy has upon clinical outcomes.

Humans↗
PubMed2005

Effects of timed voiding for the management of urinary incontinence in adults: systematic review.

AIM: The aim of this paper is to present a systematic review assessing the effectiveness of timed voiding for the management of urinary incontinence in adults. BACKGROUND: Despite the widespread use of systematic voiding programmes, their effectiveness is unclear, and the evidence for timed voiding has not been subject to rigorous and systematic evaluation. The impact on psychosocial factors and cost is also untested. The physiological basis for timed voiding is also poorly established. METHODS: The systematic review incorporated the methodology of the Cochrane Collaboration. All randomized or quasi-randomized controlled trials that addressed timed voiding for the management of urinary incontinence in adults were searched, appraised, analysed and summarized. The date of the latest search was 2002. Data were extracted independently and appraised according to the level of concealment of random allocation prior to formal entry; few and identifiable withdrawals and dropouts and an analysis based on an intention to treat. The relative risk for dichotomous data was calculated with 95% confidence intervals. Where data were insufficient to support quantitative analysis, a narrative overview was undertaken. RESULTS: Two trials of timed voiding met the inclusion criteria. In both, timed voiding was combined with other strategies. Participants were predominantly cognitively and physically impaired older women who resided in nursing home settings. Within-group improvements for the intervention groups were reported for both trials. One trial additionally reported a statistically significant reduction in night-time incontinence for the intervention group. The quality of the trials was modest and interpretation was limited by the potential for bias associated with inadequate concealment, missing data and no analysis by intention to treat. CONCLUSION: Terms used to describe voiding programmes that involve a fixed interval of voiding are variable. No conclusions can be drawn at this point about the effectiveness of timed voiding for the management of urinary incontinence in adults.

Aged, 80 and over↗
PubMed2005

A systematic review for effective management of central venous catheters and catheter sites in acute care paediatric patients.

BACKGROUND: Central venous catheters (CVCs) have provided many benefits in modern-day medical practice; however, they also put patients at risk of catheter-related complications. Numerous studies have been carried out in relation to the management of central venous catheters with conflicting results. While there were several systematic reviews of central venous catheter-related issues, it is clear that there was no systematic review of CVC-related studies specific to the paediatric population in the acute care setting. OBJECTIVE: To present the best available evidence for effective management of central venous catheters and catheter sites in the prevention and/or reduction of catheter-related complications in hospitalised paediatric patients. METHODS: A systematic review was undertaken according to the approach of the Centre for Reviews and Dissemination (CRD; http://www.york.ac.uk/inst/crd). DATA SOURCE: Literature was identified by electronic searching of Cochrane Library, MEDLINE, CINAHL, HealthSTAR, and CancerLit; checking references of all review articles; hand searching of key relevant journals and conference proceedings; and contact with expert informants, medical suppliers, and pharmaceutical companies. INCLUSION/EXCLUSION CRITERIA: The review included randomised and non-randomised controlled trials conducted with hospitalised paediatric patients. Studies that included mixed adult and paediatric populations and mixed hospitalised and home care settings were excluded. DATA EXTRACTION: Two independent reviewers extracted data onto a standard data extraction form, with differences resolved by discussion. QUALITY ASSESSMENT: The quality assessment of retrieved studies included: study design, the degree to which systematic bias was avoided or minimised, the degree to which the assessment was "blind," the degree to which follow up was completed. DATA SYNTHESIS: Quantitative pooling of studies was not feasible due to the diversity of interventions and outcome measures between similar studies. A narrative account of the study characteristics and results was therefore undertaken. RESULTS: Thirty-eight randomised and quasi-randomised controlled trials were retrieved for critical appraisal. Of these, 32 were excluded from the review because the studies did not meet the inclusion criteria and some lacked reporting of appropriate data. Six studies met the criteria with interventions such as antibiotic flushes, antiseptic skin preparations, and dressing materials. CONCLUSION: Quality of reporting was generally lacking. Statistical pooling of results was not possible due to diversity in the reporting of outcomes. There was no evidence to make recommendations on the degree of barrier precautions and the type of aseptic technique to be used at the time of catheter insertion in the paediatric population to prevent catheter-related infection. There was insufficient evidence to support the routine use of an antibiotic flushing solution. There was a lack of randomised controlled trial (RCT) evidence on the benefit of heparin flushes, the use of in-line filters, the frequency of fluid administration set changes, or the type of dressing to use and the frequency of dressing changes. There was some evidence to suggest that chlorhexidine lotion is superior to povidone iodine as a cutaneous antiseptic at the catheter insertion site. However, no recommendation can be made for the use of chlorhexidine in neonates less than 2 weeks old or in premature infants. This systematic review concluded that there is an urgent need for well-designed randomised controlled trials with sufficient power to determine the effectiveness of various interventions in relation to management of CVCs.

Adolescent↗
PubMed2004

Doctors' and nurses' perceptions of interdisciplinary collaboration in the NICU, and the impact of a neonatal nurse practitioner model of practice.

BACKGROUND: The importance of interdisciplinary collaboration has been attested to by a number of authors. Some have suggested that Nurse Practitioners (NPs) may be able to improve collaboration between doctors and nurses, but this assertion does not appear to have been researched. AIMS AND OBJECTIVES: To investigate doctors' and nurses' perceptions of interdisciplinary collaboration in two neonatal intensive care units, and to assess the impact of a Neonatal Nurse Practitioner (NNP) practice model on these perceptions. The study was conducted as part of a larger project to develop a NNP model of practice. DESIGN: Survey, pre- and post-intervention. METHODS: Medical and nursing staff in both units were surveyed before and after introduction of the NP model of practice. The instrument consisted of 25 statements relating to nurse-doctor interactions, with which respondents indicated their level of agreement on a five-point Likert scale. The Mann-Whitney U-test was used to compare scores for individual items and for overall collaboration between various groups of staff, and between the first and second surveys. RESULTS: Significant differences between the responses of nurses and doctors were found on both surveys. Areas of disagreement chiefly concerned doctors' behaviour and their attitudes towards nurses, rather than nurses' behaviour or environmental factors. Doctors consistently reported a higher degree of collaboration than did nurses. Few differences were found between first and second surveys. CONCLUSIONS: Results suggest that problems in nurse-physician interactions exist in both units. No impact of the NNP role, as established in this project, on interdisciplinary collaboration could be demonstrated. Further research in this area is warranted.

Attitude of Health Personnel↗
PubMed2004

Bridging the divide: a survey of nurses' opinions regarding barriers to, and facilitators of, research utilization in the practice setting.

BACKGROUND: Many researchers have explored the barriers to research uptake in order to overcome them and identify strategies to facilitate research utilization. However, the research-practice gap remains a persistent issue for the nursing profession. AIMS AND OBJECTIVES: The aim of this study was to gain an understanding of perceived influences on nurses' utilization of research, and explore what differences or commonalities exist between the findings of this research and those of studies that have been conducted in various countries during the past 10 years. DESIGN: Nurses were surveyed to elicit their opinions regarding barriers to, and facilitators of, research utilization. The instrument comprised a 29-item validated questionnaire, titled Barriers to Research Utilisation Scale (BARRIERS Scale), an eight-item scale of facilitators, provision for respondents to record additional barriers and/or facilitators and a series of demographic questions. METHOD: The questionnaire was administered in 2001 to all nurses (n=761) working at a major teaching hospital in Melbourne, Australia. A 45% response rate was achieved. RESULTS: Greatest barriers to research utilization reported included time constraints, lack of awareness of available research literature, insufficient authority to change practice, inadequate skills in critical appraisal and lack of support for implementation of research findings. Greatest facilitators to research utilization reported included availability of more time to review and implement research findings, availability of more relevant research and colleague support. CONCLUSION: One of the most striking features of the findings of the present study is that perceptions of Australian nurses are remarkably consistent with reported perceptions of nurses in the US, UK and Northern Ireland during the past decade. RELEVANCE TO CLINICAL PRACTICE: If the use of research evidence in practice results in better outcomes for our patients, this behoves us, as a profession, to address issues surrounding support for implementation of research findings, authority to change practice, time constraints and ability to critically appraise research with conviction and a sense of urgency.

Adult↗
PubMed2003

Implementing research findings into mental health nursing practice: exploring the clinical research fellowship approach.

The lack of research utilization within nursing practice has been extensively discussed in the literature. The Clinical Research Fellowship (CRF) program was developed to assist nurses to change practice on the basis of high-quality research evidence. This paper presents the results of a qualitative study examining the experiences of four CRF participants and three of their unit managers in completing the program and implementing changes within the clinical setting. The major themes to emerge from the data were: experience of the program, outcomes, implementation, assistance from the Centre for Psychiatric Nursing Research and Practice, Victoria, Australia, benefits and drawbacks to the program and whether it would be recommended to others. The findings indicate a positive view of the program itself although problems with the implementation stage were clearly evident. Further support following completion of the program is required to achieve maximum benefit from the program.

Attitude of Health Personnel↗
PubMed2003

Poor agreement in application of the Australasian Triage Scale to paediatric emergency department presentations.

BACKGROUND: The Australasian Triage Scale (ATS) is used in Australian emergency departments (ED) to describe patient priority on arrival. This study aimed to determine the level of inter-rater consistency with which the scale is applied to paediatric presentations. Additionally, it sought to document the level of certainty with which nurses apply the scale. METHOD: An anonymous survey of emergency nurses responsible for paediatric triage decisions using written patient profiles. RESULTS: The level of agreement between nurses applying the ATS to paediatric presentations can be described as poor and appears lower than the consistency with which it is applied to adult presentations. CONCLUSION: Inconsistent allocation of ATS category implies variable patient waiting times, which may have detrimental effects on patient condition. Hence, efforts must be made to address the inconsistency that exists in paediatric triage decision-making.

Adolescent↗
PubMed2002

Who is responsible for pediatric triage decisions in Australian emergency departments: a description of the educational and experiential preparation of general and pediatric emergency nurses.

BACKGROUND: Pediatric presentations to the emergency department (ED) account for approximately one third of ED presentations. Triage is the process employed by the ED to prioritize presenting patients, including children, on the basis of clinical urgency. This role is undertaken by emergency nurses, and a range of recommendations are available regarding the level of experience and education required by the nurse responsible for pediatric triage decisions. However, little is known about the actual education and experience of nurses undertaking pediatric triage. OBJECTIVES: To describe the level of experiential and educational preparation of emergency nurses responsible for pediatric triage decisions in pediatric and adult and pediatric population EDs. METHODS: An anonymous survey of emergency nurses responsible for pediatric triage decisions in a number of specialist and mixed EDs was conducted. RESULTS: Education and experience varies widely among nurses responsible for pediatric triage decisions. Many nurses practicing pediatric triage do not meet recognized guidelines for the levels of education and experience required to undertake pediatric triage. Nurses practicing in mixed population EDs were less likely to meet the recommended educational requirements than pediatric emergency nurses and yet reported no difference in their level of confidence in undertaking pediatric triage. CONCLUSIONS: Educationalists and managers must make a commitment to pediatric triage preparation for nurses in EDs providing pediatric services. In particular, emphasis must be placed on providing pediatric continuing education for nurses practicing in mixed population EDs. However, it is also essential that the impact of education and experience on patient outcomes be investigated before an attempt is made to influence the preparation of nurses for triage.

Adult↗
PubMed2002

Polymorphism in the IGF-I gene: clinical relevance for short children born small for gestational age (SGA).

Low birth weight is associated with an increased risk in adult life of type 2 diabetes, hypertension and cardiovascular disease (CVD). The fetal insulin hypothesis postulates that genes involving insulin resistance could effect birth weight and disease in later life (Hattersley, 1999). Besides insulin, there is extensive evidence that insulin-like growth factor-I and -II (IGF-I, IGF-II) play an important role in fetal growth. We hypothesized that minor genetic variation in the IGF-I gene could influence pre- and postnatal growth. Three microsatellite markers located in the IGF-I gene in 124 short children (height < -1.88 SDS) who were born small for gestational age (SGA) and their parents were studied. SGA was defined as both a birth weight and birth length below -1.88 SDS for gestational age. Two polymorphic markers showed transmission disequilibrium. Allele 191 of the IGF1.PCR1 marker was transmitted more frequently from parent to child (chi(2) = 4.8 and p = 0.02) and allele 198 of the 737/738 marker was transmitted less frequently from parent to child (chi(2)= 4.5 and p = 0.03). Children carrying the 191-allele had significantly lower IGF-1 levels than children not carrying this allele (-1.1 SDS vs. -0.05 SDS; p = 0.03). Also, head circumference SDS remained smaller in children with allele 191 compared to children without allele 191 (-2.1 SDS vs. -0.9 SDS; p = 0.003). Our results show that genetically determined low IGF-I levels may lead to a reduction in birth weight, length and head circumference and to persistent short stature and small head circumference in later life (proportionate small). Since low IGF-I levels are associated with type 2 diabetes and CVD, we propose that the IGF-I gene may provide a link between low birth weight and such diseases in later life.

Alleles↗