Athletes who participate in sports where performance relies on repeated high-intensity efforts could benefit from creatine (Cr) ingestion due to an increased ability to perform and recover from high-intensity exercise bouts either during training or competition. However, few studies exist which have investigated the effects of acute short-term Cr supplementation on appropriately simulated soccer-specific performance.Aims. To determine the reproducibility of a 90 minute soccer-specific performance test and to subsequently examine the effects of acute short-term Cr ingestion (1 week) on soccer-specific physical performance. Study design. Two experimental designs were adopted for this thesis. For study one, a test-retest design was used to determine the reliability and validity of the Ball-sport Endurance And Sprint Test (BEAST). Two trials of the BEAST were performed, separated by five to seven days. For study two, a randomised, triple-blind, placebo-controlled experimental design was adopted to determine the efficacy of acute short-term Cr supplementation (seven days) on soccer-specific performance, using the BEAST protocol.Methods. Twenty male amateur soccer players volunteered to participate in the study. For study one, the test-retest reliability of several soccer-specific performance measures obtained during a modified version of the BEAST was quantified using the standard error of measurement (Van Cutsem, Duchateau, & Hainaut) (or typical error) (Hopkins, 2000), coefficient of variation (CV), and Intraclass Correlation Coefficient (ICC). For study two, the cohort was split and subjects randomly allocated to one of two groups (Cr supplementation and Placebo) on a matched-pair basis. The Cr group (mean age 25.4 ± 4.5 years, mean body-mass 79.3 ± 10.5 kg) ingested 20 g of Cr and 8 g of glucose powder per day for seven days, whereas the placebo (mean age 26.7 ± 4.6 years, mean body-mass 80.8 ± 8.6 kg) group ingested 20 g of corn-flour and 8 g of glucose per day for seven days. The effects of acute short-term Cr supplementation were analysed by repeated measures ANOVA. In addition, effect sizes (ES) were calculated and entered with the associated p-value into Hopkins' spreadsheet for determination of the ES confidence limits (95%) and the chances that the true effect was substantial (i.e. ES ≥ 0.2). Clinical/practical inferences were made accordingly.Results. Study 1: The BEAST protocol had good reliability (high ICC values, relatively low coefficients of variation, low noise to signal ratios) and face validity (HR, VO2, distances covered, duration, and movements performed in the BEAST were all similar to those reported in actual soccer matches). Study 2: Performance of the four major physical measures (12 m sprint, 20 m sprint, circuit time and vertical jump) during the BEAST deteriorated during the second half relative to the first half for both Cr and placebo groups, indicating a fatigue effect associated with the protocol. HR and body-mass values also decreased for both groups during the 90 minute protocol. However, there was no statistically significant differences between the groups for these four measures or for body-mass, HR or VO2max values, suggesting Cr had no substantial effect (relative to placebo) on improving physical performance (or reducing fatigue). When the effects were assessed for the whole 90 minute BEAST protocol, all effects showed a negative trend and, correspondingly, the chances of a detrimental effect were greater than the chances of a beneficial effect.Conclusions: The 90 minute BEAST protocol had good reliability and face validity making it a suitable soccer simulation and performance protocol with which to investigate the effects of Cr supplementation on soccer performance. However, no significant (statistical or clinical) effects of acute short-term Cr supplementation on soccer performance were observed suggesting its potential use as an ergogenic aid for soccer players is questionable.

This simple quantitative descriptive case controlled research compared cases (subjects at risk for acute confusion) with controls (subjects without the attribute); comparison was made on the exposure to potential contributing factors suspected of causing acute confusion, for example, heavy smoking, or the number of alcoholic drinks consumed per day. Case-control studies were also retrospective, because they focused on conditions in the past that might have caused subjects to become cases, rather than controls. The basic purpose of this research design was essentially the same as that of experimental research: to determine the relationships among variables. This report demonstrates that, with relatively good adherence by the nursing team, proactive screening using a structured risk assessment protocol can be successfully implemented for medical patients. This assessment was associated with a statistically significant 50 per cent reduction in the incidence of acute confusion in the intervention group, compared with usual care retrospectively. Reduction in acute confusion was not associated with shortened length of stay, but length of stay was often predetermined by protocol or critical pathway. Correlation analysis demonstrated that risk screening appeared most effective in preventing or reducing acute confusion in patients without preadmission dementia or ADL impairment. In patients with significant preadmission impairment, the stress of hospitalisation may be sufficient to precipitate an episode, despite otherwise optimal management. Less-impaired patients may require additional insults to precipitate acute confusion, some of which are avertable by risk screening and subsequent early intervention. Determined risk indicators were consistent throughout the four year timeframe set for this research project. This demonstrated that although there were multiple patient types presenting to this clinical area, they were consistently the same over a longitudinal timeframe. It meant they were reproducible, which gave this research additional strength. Also, based on the descriptive statistics, this research has shown that in this clinical area where intervention was introduced the combination did have a positive impact on annual numbers of acute confusion. In summary, these findings suggest that without risk screening and the direction for appropriate management the likelihood of an episode can more than double. In the three subgroups expected to pose the greatest challenges for the risk assessment (i.e. those 70 years or older, those with suspected drug dependency, and those with symptomatic infection), risk assessment retained excellent sensitivity, (a) (d) specificity, and relevant correlation with reduction of episodes. This research has demonstrated throughout that high risk screening and associated intervention based on the risk indicator can decrease the annual number of actual episodes of acute confusion. Interventions to prevent or reduce an episode of acute confusion, as outlined by Wakefield (2002) and this research, definitely increases as a result of high risk screening. Beyond doubt, from both the literature reviewed and the findings of this research, is that risk screening does need to be adapted to the individual clinical setting and cannot be generic.

The nursing process is the espoused problem solving framework that forms the basis of the way in which patient care is determined, delivered, and communicated in a multiplicity of health care settings. Although its use is widespread in educational and clinical settings, some nurse clinicians display negative attitudes towards the use of the nursing process. They claim that both the structure and language that underpins this process is cumbersome and unreflective of the way in which nursing care is planned and delivered. To date, there has been no study cited that has examined its use within a clinical setting and determined if and how the nursing process is being used and whether there is substance in the clinicians' claims. Additionally, some of the research on problem solving has used laboratory based designs that are limited as they are not sensitive to contextual factors that affect the use of a problem solving process, nor are they sensitive to the efficacy of the communication process. As patient care involves many nurses working under diverse contextual conditions, these factors need to be taken into consideration when studying this phenomenon.Using grounded theory methodology, this study examined the clinical application of the nursing process in acute care hospital settings. Specifically, it sought to answer the following two questions: (1) How is the nursing process used by nurse clinicians in acute care hospital settings? and in the absence of its use, (2) How is nursing care determined, delivered, and communicated in acute care hospital settings in Western Australia?Data were obtained from semi-structured interviews with predominantly nurse clinicians, patients, and patients' relatives, as well as participant field observations of nurse clinicians, and in-depth audits of patient records. Textual data were managed using NUD-IST and analysed using constant ++ / comparative method. Data generation and analysis proceeded simultaneously using open coding, theoretical coding, and selective coding techniques until saturation was achieved. This resulted in the generation of a substantive theory explaining clinical nursing in acute care hospital settings.The findings of this study revealed several problems with the clinical application of the nursing process. It also revealed a process used by nurses to overcome many difficulties they experienced as they tried to determine, deliver, and communicate patient care. Specifically, nurses in this study experienced the basic social problem of being in a state of "Unknowing". Properties and dimensions of unknowing were found consistently in the data and this problem was labelled as the core category. This state of "unknowing" was linked to a number of factors, such as, the existence of a fragmented and inconsistent method of determining and communicating patient care and work conditions of immense change and uncertainty. In order to deal with this problem, the nurses in this study used a basic social process termed: "Enabling Care: Working through obscurity and uncertainty". The first phase of the core process, termed: Putting the pieces together: making sense, involved four subprocesses. These subprocesses were labelled: drawing on the known, collecting and combining information, checking and integrating information, and sustaining communication. The second phase of the core process was termed Minimising uncertainty. It involved three subprocesses which were named: adapting work practices, taking control, and backing-up.The findings of this study have implications for nursing practice, research, theory, and education, as it exposes problems with the clinical application of the nursing process in acute care settings. In addition, it further explicates a substantive theory that describes a ++ / process of nursing used by nurses in these settings. As the articulated process was supported by a number of studies and opinions of nurse scholars it is worthy of being considered as being foundational to an understanding of a process of nursing used in acute care hospital settings in Western Australia.

Thesis Erasmus University Rotterdam. / ook verschenen in gedrukte versie. With bibliogr., with a summary in Dutch.

Proefschrift Universiteit van Amsterdam. / Met lit. opg. - Met samenvatting in het Nederlands.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Thesis (Ph. D.)--Ohio State University, 2007.

Thesis (Ph.D.)--Victoria University of Wellington, 2008. / Includes bibliographical references.