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Biomedical subjects

C Watkins

Publications and source records attributed to C Watkins.

At least 37 records · Page 2Linked to original sources
PubMed1999

General practitioners' use of guidelines in the consultation and their attitudes to them.

BACKGROUND: There is concern about the apparent lack of uptake of management and referral guideline information by general practitioners (GPs) in their day-to-day consultations with patients. Little is understood about the barriers to the uptake of guidelines as perceived by GPs. AIMS: To explore how GPs gain access to and use guidelines, including computer-based guidelines, in day-to-day consultations with their patients; and to identify the perceived problems and barriers to the use of guidelines in such situations. METHOD: Postal questionnaires enquiring about the practices and attitudes towards the use of guidelines in general practice were completed by 391 of 600 randomly selected GPs in the South and West NHS region. RESULTS: GPs found guidelines a useful method of accessing expert information. Key factors in their uptake were brevity, an authoritative and unbiased source of evidence, and resonance with the GP's usual practices; they also needed to be flexible enough to incorporate individual viewpoints. Guidelines were perceived as being valuable to enable safe delegation of care to other health professionals and for sharing decision-making with patients. Dissemination of guidelines through the medium of computers was acceptable to the majority of GPs. Virtually all (93%) responders reported adapting guidelines to the needs of individual patients. Older GPs from non-fundholding practices were least likely to show a positive attitude towards guidelines. CONCLUSION: In principle, there is a very positive attitude towards the use of guidelines in general practice. However, those developing guidelines for use by GPs in the consulting room need to be aware of the factors that facilitate their use in practice. Educational strategies aimed at increasing the use of guidelines need to take into account the significant proportion who show negative attitudes towards guidelines, whose characteristics have been identified in this study.

Attitude of Health Personnel↗
PubMed1999

General practitioners' use of computers during the consultation.

This study documents the extent of reported computer use by general practitioners (GPs) in consultations with patients, and identifies barriers to their use. There was a 65% response rate from a random sample of 600 GPs in the South and West National Health Service (NHS) region who were sent a questionnaire. Ninety-one per cent (357) had a desktop computer terminal in their consulting rooms. Of these, 98% used the computer to look up information or prescribe medication, 75% entered details about selected problems presented by patients, and 36% entered information about the patient's presenting problem at every consultation. Only 18% used computers to access reference information. Use of the computer for anything other than looking up patient information or prescribing was positively associated with fundholding status and use of a personal computer at home, and was independent of number of years in practice. Sixty-five per cent of responders had positive attitudes to the inclusion of management guidelines on the computer software, and 45% of responders held positive views towards the idea of integrating management guidelines with the patient's personal computerized medical record. Consideration should be given to targeting training at those GPs who appear to be reluctant to use computers during the consultation.

Attitude to Computers↗
PubMed1998

Estimating total Barthel scores from just three items: the European Stroke Database 'minimum dataset' for assessing functional status at discharge from hospital.

BACKGROUND: The European Stroke Database (ESDB) Project aims to develop a 'common clinical language' for stroke care by agreeing on terminology, definitions and clinical assessments. Each area of stroke assessment has a 'minimum dataset', which can be collected routinely and more detailed information can be added for particular studies. Measurement of patients' functional status at discharge is essential for assessing the impact of hospital care, but even simple activities of daily living scales like the Barthel index may not be easy to use routinely on busy acute units. We thus aimed to further simplify the 20-point Barthel index by reducing it to a few key items. METHODS: We initially analysed data on 169 consecutive stroke patients discharged from one British hospital and found that a simple formula involving the combined subscores for urinary continence (Blad), bed-chair transfers C (Trans) and indoor mobility (Mob)-(Blad + Trans + Mob) x 2.39 + 0.14-predicted the total BI score to within 1 point in 79% and to within 2 points in 95% of cases. We then tested this three-item Barthel index (BI3) in four different stroke datasets (total n = 824). RESULTS: The predictions were accurate to +/-1 point in 72-81% and to +/-2 points in 88-97% of cases, and BI3 accounted for 95% of the variance in total Barthel score. It was more accurate in patients without obvious mental impairment. CONCLUSIONS: For studies involving large groups of stroke patients, it is sufficient to know about each patient's continence, transfers and indoor mobility at discharge, in order to estimate the total Barthel score. These measures have therefore been incorporated, together with a simple observational measure of cognitive status, into the database minimum dataset for short-term functional outcome and are now being validated in international studies.

Activities of Daily Living↗
PubMed1998

Use of guidelines in primary care--practitioners' perspectives.

BACKGROUND AND OBJECTIVES: Concern about the inadequate take-up of guidelines in general practice has concentrated on problems arising from the process of their development and implementation. However, these perspectives fail to take account of the needs, attitudes and problems of GPs themselves. In this study we aimed to identify barriers to the use of guidelines and opportunities for tackling them, from the point of view of the GP, so that future guideline development and policy could be more sensitive to the needs of GPs in the environment in which they work. METHOD: Twenty in-depth semi-structured interviews were audiotaped with GPs from within the Avon Health Authority area, representing GPs with different backgrounds and working environments. The transcribed data collected were analysed using a grounded theory approach. RESULTS: Utilization of guideline information is complex. GPs' appraisals of the value of guidelines interact with prior knowledge and beliefs, practicalities of existing information storage and retrieval systems, and individual working practices. Conditions where guidelines are most likely to be referred to may be those either very rarely or very commonly presenting in general practice. Key issues for the uptake of guidelines in the consultation are: general preference for certain formats of presentation; reputability and ownership; use of guidelines in shared decision-making; scope for computer-based systems; and GPs' attitudes to time pressures on information-seeking in relation to tolerance of uncertainty. CONCLUSION: Local initiatives might usefully explore the possibilities of supporting development of guideline-retrieval systems customized for individual GPs or practices. Novel means of stimulating 'ownership' and demonstrating reputability should be sought. The analysis provides a framework for understanding the complexities of the processes of GPs' use of guidelines in practice which can be useful in explaining the results of trials of guideline effectiveness. Guideline implementation occurs in the context of conflicting pressures for clinical autonomy and professional standardization and quality improvement.

Attitude of Health Personnel↗
PubMed1997

Persistence of penicillin G benzathine in pregnant group B streptococcus carriers.

OBJECTIVE: To determine if streptococcicidal levels of penicillin G benzathine can be detected in maternal serum 4 weeks after treatment with 4.8 million units. METHODS: Thirty-seven pregnant women with positive group B streptococcus vaginal or urine cultures were each given 4.8 million units of penicillin G benzathine. Maternal blood samples were collected after injection and at delivery. Serum penicillin levels were measured by high-pressure liquid chromatography. Follow-up cultures were done when possible. RESULTS: None of the patients had serum penicillin levels below 0.20 microgram/mL 30 days after treatment. Cord blood levels were approximately 50% lower than maternal levels. In all but three subjects, cord blood levels exceeded 0.06 microgram/mL, the minimal inhibitory concentration for group B streptococcus. The three exceptions were patients who delivered more than 100 days after treatment. Group B streptococcus cultures were negative at the time of delivery in 72% of cases. None of the patients with positive cultures were moderately or heavily colonized. CONCLUSION: In pregnant women, penicillin G benzathine levels are high enough to inhibit the growth of group B streptococcus for more than 4 weeks after injection with 4.8 million units. Further studies are needed to evaluate whether this regimen can prevent neonatal colonization and invasive group B streptococcus disease.

Adult↗
PubMed1994

The effect of relationship on children's distributive justice reasoning.

Kindergarten, third-grade, and sixth-grade children were told 2 stories about a group of children who made artwork that was subsequently sold at a craft fair. The characters in one story were described as friends, while the characters in the other story were described as strangers (relationship condition). 1 character in each story was presented as the oldest in the group, 1 as the most productive, and 1 as the poorest. Children were asked to allocate 9 dollars to the 3 characters under each relationship condition, provide rationales for those allocations, and rate the fairness of 4 different patterns of allocation. Older children allocated more money to needy friends than to needy strangers and more to productive strangers than to productive friends. Kindergartners' allocations and fairness ratings did not vary with relationship. Rationales for allocation judgments suggested that equality was the most salient principle for decisions at all ages, but the older children provided rationales based on benevolence more often than younger children when characters were presented as friends.

Age Factors↗
PubMed1992

Epidemiology of nondental oral disease in the elderly.

This article presents the descriptive epidemiology, risk factors, and clinical highlights of the oral mucosal lesions that are most common or of greatest concern among the elderly. Leukoplakia, oral cancer, candidiasis, lichen planus, and RAU have not been studied extensively among the elderly. Recent efforts to standardize definitions and research methods should greatly enhance future information. The paucity of research on oral lesions such as herpes zoster, epulis, and oral medication reactions is surprising, given that these are common problems among the elderly.

Aged↗
PubMed1991

How sick the baby?

Explore the source record for details and available documents.

Acute Disease↗
PubMed1986

IS1-dependent generation of high-copy-number replicons from bacteriophage P1 Ap Cm as a mechanism of gene amplification.

Mutant P1 Ap Cm lysogens were isolated in which the drug resistance genes resident on the plasmid prophage P1 Ap Cm are amplified by a novel mechanism. The first step required for amplification is IS1-mediated rearrangement of the P1 Ap Cm prophage. The drug resistance genes are amplified from the rearranged P1 Ap Cm prophage by the formation of a plasmid (P1dR) which contains the two resistance genes. The P1dR plasmid is an independent replicon about one-half the size of P1 Ap Cm that can be maintained at a copy number eightfold higher than that at which P1 Ap Cm can be maintained. It contains no previously identified replication origin and is dependent on the Rec+ function of the host.

Bacterial Proteins↗