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D A Alexander

Publications and source records attributed to D A Alexander.

At least 19 recordsLinked to original sources
PubMed2003

Assessing the communication skills of doctors in training: reliability and sources of error.

Medical examining bodies now commonly assess candidates' communication skills. However, there are a number of within-case sources of error that can mean examinations have poor reliability and validity. The aims of this study were to determine the main within-case sources of error and to identify the best methods of maximising reliability in highly structured communication skills assessments. Subjects were fifth year medical students at the University of Aberdeen. Subjects were videotaped giving clinical information to standardised patients and relatives toward the end of their fifth year and toward the end of their pre-registration year. Sources of variation, reliability coefficients and the most effective methods of reducing measurement error were calculated using generalisability theory. Systematic differences among subjects' communication skill was the main source of variation in two of the three assessment cases. The implications of the results are discussed.

Communication↗
PubMed2003

Bioterrorism: preparing for the unthinkable.

Terrorism is not a new concept but our need to prepare for the effects of bioterrorism has achieved a particular urgency. The use of biological agents provides a new set of challenges to professional caregivers, emergency personnel and Governments. These agents are generally not readily identified through the senses, have delayed effects and have the power to generate fear and panic. They are also intended to demonstrate that Governments and other organisations are not able to protect their citizens and members. What evidence there is suggests bioterrorist incidents have the potential to create higher levels of psychopathology than physical injury. Therefore, the authorities must identify and rehearse suitable methods of psychoprophylaxis and intervention.

Anthrax↗
PubMed2002

The Aberdeen Trauma Screening Index: an instrument to predict post-accident psychopathology.

BACKGROUND: A key challenge in trauma care is the prevention of psychopathology. However, no definitive method of identifying individuals at risk of developing psychopathology exists. The Aberdeen Trauma Screening Index (ATSI) is a brief screening tool developed for use in a clinical setting by non-mental health professionals to facilitate the early identification of individuals most at risk of psychopathology 3-months post-accident. METHODS: The ATSI derived from a prospective study of a 150 out of an initial pool of 213 consecutive admissions to the Orthopaedic Trauma Unit and the Accident and Emergency Department of Aberdeen Royal Infirmary. Potential predictors were identified by a comprehensive assessment conducted within 1-week post-accident. Outcome at 3-months post-accident was measured using 'caseness' according to the General Health Questionnaire (GHQ-28). RESULTS: The ATSI is based on a final model comprising only seven variables with a sensitivity of 79% and specificity of 65%. A predictive index score (0-100) was produced to ensure the practical utility of the ATSI in a clinical setting. A ROC curve was constructed to illustrate the relationship between sensitivity and the specificity values with their corresponding threshold scores. On the basis of a prevalence rate of 55% 'caseness', as identified in the present study, a cut-off point of 45 provides the optimal outcome with a sensitivity value of 70% and a specificity value of 71%. CONCLUSIONS: The ATSI can accurately identify those most at risk of developing psychopathology 3-months post-accident in a sample of accidentally injured adult subjects recruited as consecutive admissions to an urban hospital in the North East of Scotland. However, to establish the generalizability of these findings, it is important that the ATSI be validated in both similar and diverse populations.

Accidents↗
PubMed2002

A waste of time: non-attendance at out-patient clinics in a Scottish NHS Trust.

UNLABELLED: The Patient's Charter states that patients have a responsibility to attend out-patient appointments or to notify the hospital if they are unable to do so. Non-attendance without notification has substantial financial costs for the NHS and may have clinical implications to the non-attender and other patients on the waiting list. OBJECTIVE: To identify reasons for non-attendance of patients for their first appointment after referral. DESIGN: A survey by questionnaire of a random sample of non-attenders of an NHS trust. SETTING: Aberdeen Royal Hospitals NHS Trust. SUBJECTS: Ten per cent of all non-attenders to the Trust out-patient clinics over a twelve month period. RESULTS: One hundred and fifty five (32%) patients contributed to the survey. Cancellations accounted for 22% (34) of missed appointments with factors relating to illness or treatment, being the most common reason (14; 44%). Patients failing to attend without prior notification stated that hospital administrative problems (75; 57%) and personal administrative problems (31; 23%) were the primary reasons. Clinical speciality, day of the week, the month, availability of a telephone or car, and socioeconomic group were not significantly associated with non-attendance. CONCLUSION: The majority of patients show a responsible attitude to attendance at outpatients when appointments were received. Non-attendance was found to be due to a combination of institutional factors (commonly administrative) and patient factors such as forgetting about the appointment.

Adult↗
PubMed2001

C-reactive protein and interleukin 6 receptor in post-traumatic stress disorder: a pilot study.

BACKGROUND: it has been reported that psychological stress in humans is associated with a derangement of biological homeostasis. This pilot study aimed to examine the inflammatory response to post-traumatic stress disorder (PTSD) through measurements of the serum levels of the receptor to interleukin 6 (sIL-6r) and C-reactive protein (CRP), in relation to measures of psychological disturbance. METHODS: 15 patients with established PTSD and eight control patients with musculoskeletal injuries were studied at least three months after their index trauma. All completed revised impact of events scale (RIES), Davidson's trauma scale (DTS) and the general health questionnaire (GHQ), and gave blood samples that were assayed for CRP and sIL-6r. Statistical analysis was by the Mann-Whitney U-Wilcoxon rank sum tests. RESULTS: positive relationships were found between sIL-6r and the RIES intrusion score (P=0.026), and between CRP and DTS intrusion scores (P=0.016), GHQ depression (P=0.028), and RIES intrusion (P=0.044) in the case group. DISCUSSION: we have demonstrated a relationship between post-traumatic psychological and biological disturbance, which provides the basis for further research on the effects of psychological disturbance on physical recovery after injury.

Adolescent↗
PubMed2001

Psychiatric sequelae and psychosocial adjustment following ocular trauma: a retrospective pilot study.

AIMS: To identify the prevalence of psychiatric and adjustment problems after ocular trauma and those factors related to a poor outcome. METHODS: 47 patients were assessed by structured interview, of whom 45 satisfactorily completed three standardised self report measures of psychological functioning, subjective distress, and social adjustment. RESULTS: 33% of patients displayed psychiatric "caseness". A number of features of the victim consistently resulted in poor outcome including a psychiatric history and peritraumatic dissociation. CONCLUSION: These preliminary findings suggest ocular trauma is associated with psychomorbidity and problems of adjustment. The improved management of such patients would benefit from a more detailed analysis by means of a longitudinal study involving larger samples.

Adaptation, Psychological↗
PubMed2001

Ambulance personnel and critical incidents: impact of accident and emergency work on mental health and emotional well-being.

BACKGROUND: The association between mental health and occupational factors among ambulance personnel has not been thoroughly investigated in the UK. AIMS: To identify the prevalence of psychopathology among ambulance personnel and its relationship to personality and exposure to critical incidents. METHOD: Data were gathered from ambulance personnel by means of an anonymous questionnaire and standardised measures. RESULTS: Approximately a third of the sample reported high levels of general psychopathology, burnout and posttraumatic symptoms. Burnout was associated with less job satisfaction, longer time in service, less recovery time between incidents, and more frequent exposure to incidents. Burnout and GHQ-28 caseness were more likely in those who had experienced a particularly disturbing incident in the previous 6 months. Concerns about confidentiality and career prospects deter staff from seeking personal help. CONCLUSIONS: The mental health and emotional well-being of ambulance personnel appear to be compromised by accident and emergency work.

Adaptation, Psychological↗
PubMed2001

Caring for others can seriously damage your health.

To care for others is a privilege and a source of personal and job satisfaction. However, caregivers must also consider the implications of their work for their own health and welfare.

Adaptation, Psychological↗
PubMed2001

Nairobi terrorist bombing: the personal experience of a mental health adviser.

This is a personal account of the author's involvement as an adviser in the wake of the Nairobi terrorist bombing in 1998. Much has been written in the literature about the problems for and reactions of first responders, emergency personnel and those who provide care for victims of trauma. Less is known about the role of the specialist adviser. The author describes the terrorist incident, how the Kenyans responded to it and his own role. He also highlights important learning points, dilemmas and challenges which an adviser might encounter.

Crisis Intervention↗
PubMed2000

Suicide by patients: questionnaire study of its effect on consultant psychiatrists.

OBJECTIVE: To identify the effect of patients' suicide on consultant psychiatrists in Scotland. DESIGN: Confidential coded postal questionnaire survey. PARTICIPANTS: Of 315 eligible consultant psychiatrists, 247 (78%) contributed. SETTING: Scotland. MAIN OUTCOME MEASURES: Experience of patient suicide; the features and impact of "most distressing" suicide and what helped them to deal with it. RESULTS: 167 (68%) consultants had had a patient commit suicide under their care. Fifty four (33%) reported being affected personally in terms of low mood, poor sleep, or irritability. Changes in professional practice were described by 69 (42%) of the psychiatrists-for example, a more structured approach to the management of patients at risk and increased use of mental health legislation. Twenty four (15%) doctors considered taking early retirement because of a patient's suicide. Colleagues and family or friends were the best sources of help, and team and critical incident reviews were also useful. CONCLUSIONS: Suicide by patients has a substantial emotional and professional effect on consultant psychiatrists. Support from colleagues is helpful, and professional reviews provide opportunities for learning and improved management of suicide and its aftermath.

Emotions↗
PubMed2000

Normal and pathological reactions to severe stress: their features and management.

It is unethical and incompetent to deny the scale and nature of human reactions to trauma. Those who provide care for victims of trauma should be familiar with normal and pathological reactions following trauma and know how to identify those at high risk of developing adverse reactions and problems of adjustment. Methods of treating and preventing post-traumatic conditions have not been evaluated with sufficient rigour. There are, however, some guiding principles to ensure a rational approach to the management of victims of trauma.

Adaptation, Psychological↗
PubMed2000

Personal safety and the abuse of staff in a Scottish NHS Trust.

BACKGROUND: An employer's 'duty of care' is enshrined in statute and common law. This responsibility extends to identifying areas of risk to employee's safety and emotional well being. OBJECTIVE: To identify the views of NHS staff on their safety and exposure to assault and other forms of abuse. DESIGN: A survey by questionnaire and semi-structured interview of the staff of an NHS Trust. SETTING: A large Scottish NHS Trust. SUBJECTS: All 5365 staff of the Trust. RESULTS: Two thousand two hundred and ninety four (43%) employees contributed to this survey. With regard to exposure to hazardous substances and serious infection, most staff were satisfied with safety standards and guidelines. Over a 12 month period 23% of the workforce had been assaulted, mainly by patients and 63% had experienced verbal abuse, again, mainly from patients. There were differences among occupational groups but overall 16% had been bullied; 18% had suffered discrimination; 22% had experienced harassment, and 13% had been victimized. Only 42% of individuals reported their most distressing incidents; 56% of them regarded the outcome of their reports as satisfactory. CONCLUSIONS: Staff are generally satisfied with the steps taken to safeguard them against hazardous substances and serious infection. Assault by and abuse from patients is a considerable risk, especially for trained nurses. In terms of bullying, harassment, discrimination and victimization, the abuse of power by colleagues is also a distressing and under-reported phenomenon which needs to be addressed by regular audit and the creation of a climate in which employees feel secure enough to report such abuse and to have faith in the mechanisms set up to deal with such complaints.

Attitude of Health Personnel↗
PubMed1999

The ion coupling and organic substrate specificities of osmoregulatory transporter ProP in Escherichia coli.

Transporter ProP of Escherichia coli, a member of the major facilitator superfamily, mediates osmoprotective proline or glycine betaine accumulation by bacteria exposed to high osmolality environments. Morpholinopropane sulfonic acid, a common constituent of microbiological media, accumulates in osmoadapting E. coli cells but it is not osmoprotective and it did not influence proP transcription or ProP activity. The apparent K(m) for proline uptake via ProP increased with decreasing pH in the range 7.5-4. ProP-dependent proline uptake by de-energized bacteria was associated with alkalinization of the external medium. Thus ProP mediates cotransport of H(+) and zwitterionic proline and a transporter functional group with a pK(a) of 5-6 is implicated in catalysis. Exogenous proline or glycine betaine elicits K(+) release from osmoadapting E. coli cells and ProP activity is stimulated by exogenous K(+). However, uptake of proline or glycine betaine stimulated K(+) efflux from K(+)-loaded bacteria which expressed either ProP or alternative, osmoregulatory transporter ProU. This indicated that ProP was unlikely to mediate K(+) efflux. Zwitterions ectoine, pipecolate, proline betaine, N,N-dimethylglycine, carnitine and 1-carboxymethylpyridinium were identified as alternative ProP substrates. Choline, a cation and a structural analogue of glycine betaine, was a low affinity inhibitor but not a substrate of ProP.

Bacterial Proteins↗
PubMed1997

A pragmatic randomised comparison of transcervical resection of the endometrium with endometrial laser ablation for the treatment of menorrhagia.

OBJECTIVE: To compare endometrial laser ablation (ELA) with transcervical resection of the endometrium (TCRE) in the treatment of menorrhagia. DESIGN: Randomised controlled trial. SETTING: Gynaecology department of a large teaching hospital. PARTICIPANTS: Women with menorrhagia due to dysfunctional uterine bleeding (n = 372) were randomly allocated to ELA (n = 188) or TCRE (n = 184). MAIN OUTCOME MEASURES: Operative complications, post-operative recovery, relief of menstrual and other symptoms, need for further surgical treatment, satisfaction with treatment after 6 and 12 months, and differential resource use. RESULTS: TCRE was significantly quicker, with lower rates of fluid overload. Perioperative morbidity was low and similar in both groups. Outcome at 12 months was also similar: 72 women (45%) had either amenorrhoea or brown discharge in the ELA group compared with 71 (49%) in the TCRE group; 79 (49%) versus 68 (46%) had lighter periods. Thirty (16%) versus 36 (20%) had received further surgical treatment: 9 (5%) compared with 25 (14%) had had a hysterectomy and 21 (11%) versus 11 (6%) had received repeat ablation. Anxiety and depression, dysmenorrhoea and pre-menstrual symptoms were improved by both procedures and bladder symptoms were affected by neither. At 12 months 148 (90%) women in the ELA group and 140 (91%) women in the TCRE group were satisfied with their treatment. The estimated additional cost of ELA was Pound 145 per procedure. CONCLUSIONS: At one year there was no clear difference in clinical outcome between ELA and TCRE. Both procedures were associated with low morbidity. ELA was the more costly procedure. Despite the need for further surgery for about one in six women, satisfaction rates were high following both ELA and TCRE.

Adult↗
PubMed1996

Randomised trial comparing hysterectomy with endometrial ablation for dysfunctional uterine bleeding: psychiatric and psychosocial aspects.

OBJECTIVE: To compare in psychiatric and psychosocial terms the outcome of hysterectomy and endometrial ablation for the treatment of dysfunctional uterine bleeding. DESIGN: Prospective randomised controlled trial. SETTING--Obstetrics and gynaecology department of a large teaching hospital. SUBJECTS: 204 women with dysfunctional bleeding for whom hysterectomy would have been the preferred treatment were recruited over 24 months and randomly allocated to hysterectomy (99 women) or to hysteroscopic surgery (transcervical resection (52 women) or laser ablation (53 women). MAIN OUTCOME MEASURES: Mental state, martial relationship, psychosocial and sexual adjustment in assessments conducted before the operation and one month, six months, and 12 months later. RESULTS: Both treatments significantly reduced the anxiety and depression present before the operation, and there were no differences in mental health between the groups at 12 months. Hysterectomy did not lead to postoperative psychiatric illness. Sexual interest after the operation did not vary with treatment. Overall, 46 out of 185 (25%) women reported a loss sexual interest and 50 out of 185 (27%) reported increased sexual interest. Marital relationships were unaffected by surgery. Personality and duration of dysfunctional uterine bleeding played no significant part in determining outcome. CONCLUSIONS: Hysteroscopic surgery and hysterectomy have a similar effect on psychiatric and psychosocial outcomes. There is no evidence that hysterectomy leads to postoperative psychiatric illness.

Adaptation, Psychological↗