In the morale maze.
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Clinical Protocols↗
Biomedical subjects
A Spooner
Publications and source records attributed to A Spooner.
What makes British general practitioners take part in a quality improvement scheme?
OBJECTIVES: To understand the reasons for the apparent success of a quality improvement scheme designed to produce widespread changes in chronic disease management in primary care. METHODS: Purposeful sample of 36 primary care staff, managers and specialists. Qualitative analysis of 27 interviews in East Kent Health Authority area, where, over a three-year period, more than three-quarters of general practitioners (GPs) and enrolled in a quality improvement programme which required them to meet challenging chronic disease management targets (PRImary Care Clinical Effectiveness--PRICCE). RESULTS: Major changes in clinical practice appeared to have taken place as a result of participation in PRICCE. The scheme was significantly dependent on leadership from the health authority and on local professional support. Factors that motivated GPs to take part in the project included: a desire to improve patient care; financial incentives; maintenance of professional autonomy in how to reach the targets; maintenance of professional pride; and peer pressure. Good teamworking was essential to successful completion of the project and often improved as a result of taking part. The scheme included a combination of interventions known to be effective in producing professional behavioural change. CONCLUSIONS: When managerial vision is aligned to professional values, and combined with a range of interventions known to influence professional behaviour including financial incentives, substantial changes in clinical practice can result. Lessons are drawn for future quality improvement programmes in the National Health Service.
Chronic Disease↗
The apical ligament: anatomy and functional significance.
OBJECT: The authors conducted a study to describe the detailed anatomy of the apical ligament and to acknowledge or refute its historical description as a functionally significant contributor to craniocervical stability. METHODS: In 20 adult human cadavers measurements of the apical ligament were obtained, and its detailed anatomy was observed. Ranges of motion were also assessed to discern the function of the apical ligament. CONCLUSIONS: Results of the study support the concept that the apical ligament is best described as a vestigial structure that offers no significant added stability to the craniocervical junction. In fact, this ligament was absent in 20% of the specimens examined. These data will aid physicians who frequently view images or manage clinical problems of the craniocervical junction because they may focus on other ligaments of this area and not the apical ligament.
Adult↗
Intraepithelial lymphocytes in normal human intestine do not express proteins associated with cytolytic function.
Human small intestine contains a very large population of intraepithelial T lymphocytes (IELs) that are oligoclonal, appear functionally to be cytolytic T cells, and may contribute to the normal and pathological turnover of intestinal epithelial cells. This report addresses the cytolytic function of IELs in normal small intestine by examining their expression of molecules that carry out cell-mediated cytolysis. Immunohistochemical analyses of granzyme B, perforin, Fas ligand, and tumor necrosis factor-alpha demonstrated these proteins were not expressed by small intestinal IELs in situ. These proteins also were not expressed by colonic IELs or by lamina propria lymphocytes in the small or large intestine. Granzyme A, however, was expressed by a large fraction of IELs. In contrast to these in situ results, isolated and in vitro activated IELs were shown to express effector proteins consistent with cytolytic T cells, including granzyme B, Fas ligand, tumor necrosis factor-alpha, and interferon-gamma. These results are most consistent with the vast majority of IELs in normal human small intestine being resting cytolytic T cells and suggest that these cells do not contribute to the apoptotic cell death of epithelial cells in normal intestine.
Fas Ligand Protein↗
The future direction of general practice.
Examines the present strengths and weaknesses of the general practice system. Proposes a different structure for the future which should provide benefits for both the purchasers and providers of health care, as well as for the patients themselves.
Budgets↗
A personal perspective: the psychological needs of spine-injured patients.
1. The immediate needs of spine-injured patients, families and friends is for answers, advice, support and counselling. 2. Newly injured patents and their families and friends need continuous support and information throughout long-term rehabilitation. 3. Consideration must be given to the injured patient as a whole person because physical and psychological rehabilitation are dependent on each other.
Counseling↗
Keeping body and soul together.
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Accidental Falls↗