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Biomedical subjects

C McIntosh

Publications and source records attributed to C McIntosh.

At least 19 recordsLinked to original sources
PubMed2002

Is multidisciplinary learning effective among those caring for people with diabetes?

The role of multi-professional learning for those providing clinical services to people with diabetes has yet to be defined. Several assumptions are generally made about education in the context of multi-professional settings. It is argued that different professions learning together could potentially improve professional relationships, collaborative working practices and ultimately standards of care. Greater respect and honesty may emerge from a team approach to learning with a commensurate reduction in professional antagonism. Personal and professional confidence is reportedly enhanced through close contact with other professionals during team-based learning exercises. We have examined current evidence to support multidisciplinary learning in the context of medical education generally as well as in diabetes education. Previous investigation of available literature by Cochrane reviewers, aimed at identifying studies of interprofessional education interventions, yielded a total of 1042 articles, none of which met the stated inclusion criteria. Searches involving more recent publications failed to reveal more robust evidence. Despite a large body of literature on the evaluation of interprofessional education, studies generally lacked the methodological rigour needed to understand the impact of interprofessional education on professional practice and/or health care outcomes. Nevertheless, planners continue to advocate, and endorse, joint training between different groups of workers (including nurses, doctors and those in professions allied to medicine) with the objective of producing an integrated workforce of multidisciplinary teams. Whilst the concept of multi-professional learning has strong appeal, it is necessary for those responsible for educating health care professionals to demonstrate its superiority over separate learning experiences.

Costs and Cost Analysis↗
PubMed2001

Retrospective collection of exposure data from industry: results from a feasibility study in the United Kingdom.

In the United Kingdom the Health and Safety Executive for some years has stored chemical exposure data in their National Exposure Database. However, it has been difficult to persuade industry and other organizations to contribute to this resource. The aim of this project was to devise a cost-effective method of obtaining occupational exposure data on chemicals from U.K. industry and other sources. Five strategies were used to identify data for three different substances: toluene, acrylonitrile, and ethylene oxide. In total, 810 organizations were contacted and over 45 percent responded. However, only 40 had relevant exposure data. Almost equal numbers of acceptable measurements were identified for toluene and acrylonitrile (2,770 and 2,000 respectively) with lesser ethylene oxide data (800). These measurements were drawn from a wide range of industries and are probably representative of measurements made by U.K. industry, although most of the data were from companies employing more than 100 people. During the second phase of the project, more than 3,000 measurements and associated contextual information were collected (499 for toluene, 1,516 for acrylonitrile, and 17 for ethylene oxide, with a further 1,004 measurements for 1 of 27 substances collected simultaneously with one of the above). The costs of identifying and collecting exposure data ranged from ł7 to ł380 per valid measurement, depending on the source of the data. We suggest that, rather than trying to retrospectively collect data, it is likely to be more cost-effective to enlist a number of occupational hygiene consults and industrial organizations to prospectively provide anonymized exposure measurements for inclusion in the Health and Safety Executives National Exposure Database.

Data Collection↗
PubMed2000

Joint liaison psychiatry-diabetes clinic: a new specialist service.

AIMS: Specialist diabetes clinics have an established role in prevention and management of complications. As psychological problems are usually treated separately from diabetes centres, the role of a specialist psychiatrist within a teaching hospital was assessed. The aims of the study were to describe referral patterns, specific psychiatric conditions and treatments offered. RESULTS: During weekly outpatient sessions over a 12-month period, 31 patients were referred with a wide range of psychiatric diagnoses. One-third of patients were seen on the day and two-thirds within 2 weeks of referral. Treatments included anti-depressant medication, counselling and cognitive behaviour therapy. Successful discharge was obtained in 10 subjects and eight were undergoing continued treatment. CONCLUSIONS: The range of specific diagnoses requiring psychiatric supervision supported the role of specifically trained personnel as seen in a joint liaison psychiatry-diabetes service.

Adult↗
PubMed1999

Bleeding peptic ulcers: audit of eradication treatment for H pylori.

AIMS: To determine the outcomes after presentation with bleeding peptic ulcer and to assess the implementation of H. pylori testing, treatment and follow-up testing. METHODS: Case notes and endoscopy records of patients presenting to Auckland Hospital between 1993-95 were reviewed. Patients were recalled for interview and urea breath test. RESULTS: Mean follow-up after presentation was three years. Eighty-nine patients were reviewed; 62% were confirmed as H. pylori positive, although 20% had no biopsies. H. pylori eradication treatment was given to 49 patients. Thirty-five patients had a definite treatment success; eight were failures (eradication rate of 81%) and six received treatment without proof of H. pylori by biopsy. Forty patients received acid suppression only. Twelve patients had biopsy evidence of H. pylori, and a further nine were proven H. pylori positive at follow-up by urea breath test (initial tests had been negative or not performed). Nine patients had a rebleed; seven were confirmed H pylori positive either at presentation, or by follow-up breath test or endoscopic biopsies. CONCLUSIONS: The incidence of H. pylori in patients with bleeding peptic ulcer is underestimated and many infected patients do not receive eradication treatment. Rebleeding is largely preventable if more attention is given to diagnosis and treatment of H. pylori and follow-up of treatment with a urea breath test.

Anti-Bacterial Agents↗
PubMed1998

Can the urea breath test for H.pylori replace endoscopy for the assessment of dyspepsia in primary care?

AIMS: The urea breath test may have value in the initial assessment of dyspepsia in primary care. This pilot study tracks patient and general practitioner behaviour which cannot be predicted with modelling studies. METHODS: The urea breath test was made available over a period of 18 months. The test was requested when general practitioners would normally have used a trial of medication or referred for endoscopy. Patients with a positive urea breath test had early endoscopy before treatment. Patients with a negative urea breath test were treated according to symptom response. A follow-up questionnaire was given 6-24 months after the urea breath test. RESULTS: Urea breath tests were requested on 249 patients; clinical notes and follow-up interview data were available for 207 patients (83%). The urea breath test was positive for 89 patients (43%); 70 were referred for endoscopy and peptic ulcer disease was found in 33 (47%). The urea breath test was negative for 118 patients; 14 were follow-up tests after previous H.pylori treatment. For the 104 patients with dyspepsia, a negative test and no previous treatment, 42% had 1 or more previous investigations for dyspepsia and 66% had dyspepsia symptoms for more than one year. During follow-up, 21 patients had endoscopy. Dyspepsia symptom scores were significantly lower at follow-up (p < 0.01). Using a global assessment, 66% had fewer symptoms, 22% same and 12% had more symptoms. The symptom improvement was greater if the duration of symptoms was less than one year (p < 0.05). Medication use did not change significantly. Twelve patients were dissatisfied with management; most of these would have preferred endoscopy. CONCLUSIONS: A negative urea breath test appears to have some reassurance value. The use of the urea breath test as initial assessment for dyspespia may prevent the need for some endoscopy. Further controlled studies of breath testing compared with early endoscopy are required.

Adult↗
PubMed1997

A noninvasive method for distinguishing among canid species: amplification and enzyme restriction of DNA from dung.

Endangered San Joaquin kit foxes Vulpes macrotis mutica can be sympatrically distributed with as many as four other canids: red fox, gray fox, coyote and domestic dog. Canid scats are often found during routine fieldwork, but cannot be reliably identified to species. To detect and study the endangered kit fox, we developed mitochondrial DNA markers that can be amplified from small amounts of DNA extracted from scats. We amplified a 412-bp fragment of the mitochondrial cytochrome-b gene from scat samples and digested it with three restriction enzymes. The resulting restriction profiles discriminated among all five canid species and correctly identified 10 'unknown' fox scats to species in blind tests. We have applied our technique to identify canids species for an environmental management study and a conservation study. We envision that our protocol, and similar ones developed for other endangered species will be greatly used for conservation management in the future.

Animals↗
PubMed1996

Scanning electron microscope sizing of airborne fibre samples: a preliminary investigation into the effects of the variable inclination of fibres to filter surfaces.

The scanning electron microscope (SEM) method of fibre sizing assumes that all fibres lie flat on filters. This appears to be true for samples deposited from aqueous suspension, but in some airborne samples only about 60% of fibres lie flat on the filter surface and many of the rest are balanced at high angles to the filter surface. These inclined fibres will appear foreshortened when the filter surface is viewed in conventional orientation during SEM analysis. This could lead to an underestimation of fibre length and some fibres may be so foreshortened that they do not appear to fulfil the criteria of a fibre. The results of a preliminary investigation of the effects of variable fibre inclination in fibre counts and size data for two fibre types suggest that the SEM data do give an underestimate of the number, length and therefore volume of longer fibres in some samples. This suggests that it is important to consider fibre inclination when SEM analysis of airborne fibre samples is performed. Our preliminary observations suggest that is unlikely that it will be possible to derive widely applicable correction factors to allow for orientation effects.

Air Pollutants, Occupational↗
PubMed1996

Student reflective groups at a Scottish College of Nursing.

In this paper student views on reflective groups, set up as an important element of the new Project 2000 course in a Scottish College of Nursing, are reported. A random sample of 19 students were interviewed. While the reflective groups were very popular with students because they provided support, there was little evidence of a linkage between theory and practice. It was clear that the ambitious objective of stimulating reflection-on-action was not attained. Practice certainly was discussed, but it tended to be dominated by dramatic and emotionally charged aspects of care rather than the more frequent routine concerns. There were, however, indications that the original aim of the reflective groups could be achieved if tutors could establish a common understanding of the purpose of the groups and of reflection, and if the practices on which students reflected consisted less of single day visits where the students saw themselves as nonparticipant outsiders.

Education, Nursing, Baccalaureate↗
PubMed1996

Large differences in substitutional pattern and evolutionary rate of 12S ribosomal RNA genes.

We demonstrate using Drosophila, periodical cicadas, and hominid primates, that the molecular clock based on animal mitochondrial small-subunit (12S) rRNA genes ticks at significantly different relative rates depending on which taxa and which region of the gene are examined. Drosophila, which are commonly used as model taxa, are evolving in a highly peculiar manner with the majority of sites in the 3' half of the 12S gene apparently invariant. The analogous 3' half of the mitochondrial large-subunit rRNA gene (16S) appears to be similarly constrained. It is surprising that these regions that are already highly constrained in all animals should be even more constrained in Drosophila, especially when the Drosophila mitochondrial genome as a whole does not display a similar rate slowdown. This extreme 12S rate slowdown is not apparent in periodical cicadas or hominid primates and appears to be related to strong structural and functional constraints rather than a depressed mutation rate. Finally, the slow average rate of evolution in the third domain of Drosophila does not imply that the few variable sites lack multiple hits.

Animals↗
PubMed1996

Situating theory in practice: student views of theory-practice in Project 2000 nursing programmes.

In this paper the views of student nurses taking Project 2000 at a Scottish College of Nursing are reported. A random sample of 19 students were interviewed. The interviews focused on the relationship between the college course and the students' experiences on placement. The majority had difficulty in relating the college course to their practice, except when it came to very specific parts of the programme, for example basic medical procedures. Only a minority could integrate the broader aspects of the course to their practice, largely because there was such a long period of time between studying a topic in college and the related placement. It is tempting to see the results as supporting the situated cognition hypothesis that theory loses meaning out of context, and it is evident, even from this limited study, that the success of Project 2000, with its emphasis on the 'knowledgeable doer', could depend, to a great extent, on the careful phasing of college coursework and placement to enable students to integrate theory and practice more effectively.

Attitude of Health Personnel↗
PubMed1994

Beta-funaltrexamine blockade of opioid-induced inhibition of somatostatin secretion from rat stomach.

Opioid peptides are potent inhibitors of gastric somatostatin secretion. In the current investigation the effect of mu-opioid receptor blockade on responses to [D-Ala2,N-Me-Phe4,Gly5-ol]enkephalin (DAGO) was studied. Gastric inhibitory polypeptide (GIP; 1 nM) -stimulated secretion of immunoreactive somatostatin was almost completely inhibited by DAGO (1 microM). The mu-receptor antagonists, beta-funaltrexamine and naloxonazine, blocked the effect of DAGO. Pretreatment of rats with beta-funaltrexamine, 24 h prior to perfusion, reduced the percentage inhibition by DAGO from 88.6 +/- 5.2% to 50.7 +/- 9.3%. These studies support the involvement of mu-opioid inhibitory receptors in the regulation of gastric somatostatin secretion.

Amino Acid Sequence↗
PubMed1992

Glutathione: new candidate neuropeptide in the central nervous system.

The physiological significance of glutathione in the mammalian central nervous system is still uncertain, although some evidence indicates that it may be an important regulatory peptide. In the present study, the distribution and characteristics of glutathione binding sites in the brain have been studied. Biotinyl-glutathione was synthesized as a probe to detect glutathione binding sites in the CNS. Specific glutathione binding sites in the brain were largely localized to the white matter, suggesting the presence of glutathione receptors on neuroglial cells. The colloidal gold technique and immunofluorescence double staining allowed the visualization of the receptor at the cellular level and thus demonstrated that there are glutathione receptors on cultured astrocytes. Glutathione applied to cultured astrocytes elicited increased levels of intracellular inositol-1,4,5-trisphosphate, suggesting that glutathione receptors were coupled to phospholipase C. The localization of glutathione receptors on astrocytes and the activation of a second messenger system by glutathione suggest that glutathione may be a neuropeptide in the central nervous system.

Animals↗