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Biomedical subjects

D Weller

Publications and source records attributed to D Weller.

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

Clinical practice guidelines and Australian general practice. Contemporary issues.

BACKGROUND: This paper summarises recent important clinical practice guideline initiatives in Australia which have direct relevance to Australian general practice. OBJECTIVE: Activities of the National Health and Medical Research Council (NH&MRC), professional groups and the Commonwealth Department of Health's General Practice Strategy including relevant outputs of the General Practice Evaluation Program are examined in detail. This paper provides criteria for GPs to assess whether a clinical practice guideline is likely to be practical and useful for them. It examines the future development of guidelines and emphasises the need for a clearer understanding of the GP role in this and highlights strategies for overcoming barriers to implementation. DISCUSSION: While a great deal of effort has been invested in clinical practice guideline development and implementation, further development and focussed effort on dissemination is needed if they are to fulfill their potential to improve clinical practice. Australian general practice presents a number of challenges and barriers to successful uptake including lack of computerisation, attitudinal barriers and variable coverage of clinical issues in existing guidelines. Concern about the nature and purpose of guidelines is also frequently expressed.

Australia↗
PubMed1998

A systematic review of the effects of screening for colorectal cancer using the faecal occult blood test, hemoccult.

OBJECTIVE: To review effectiveness of screening for colorectal cancer with faecal occult blood test, Hemoccult, and to consider benefits and harms of screening. DESIGN: Systematic review of trials of Hemoccult screening, with meta-analysis of results from the randomised controlled trials. SUBJECTS: Four randomised controlled trials and two non-randomised trials of about 330 000 and 113 000 people respectively aged >=40 years in five countries. MAIN OUTCOME MEASURES: Meta-analysis of effects of screening on mortality from colorectal cancer. RESULTS: Quality of trial design was generally high, and screening resulted in a favourable shift in the stage distribution of colorectal cancers in the screening groups. Meta-analysis of mortality results from the four randomised controlled trials showed that those allocated to screening had a reduction in mortality from colorectal cancer of 16% (relative risk 0.84 (95% confidence interval 0.77 to 0.93)). When adjusted for attendance for screening, this reduction was 23% (relative risk 0.77 (0.57 to 0.89)) for people actually screened. If a biennial Hemoccult screening programme were offered to 10 000 people and about two thirds attended for at least one Hemoccult test, 8.5 (3.6 to 13.5) deaths from colorectal cancer would be prevented over a period of 10 years. CONCLUSION: Although benefits of screening are likely to outweigh harms for populations at high risk of colorectal cancer, more information is needed about the harmful effects of screening, the community's responses to screening, and costs of screening for different healthcare systems before widespread screening can be recommended.

Adult↗
PubMed1998

Prostate cancer testing in SA men: influence of sociodemographic factors, health beliefs and LUTS.

This study investigates the prevalence and determinants of prostate cancer screening in the South Australian community. An interview-based survey of a probability sample of the SA population (N = 3,016) in 1995 addressed previous PSA testing, beliefs about vulnerability to prostate cancer and efficacy of screening, presence of uncomplicated lower urinary tract symptoms (LUTS) and sociodemographic variables. Of 736 men, 40 years and over with no history of prostate cancer, 24.7% (182/736) reported ever having had a test and 53.9% (397) reported an intention to test; 74% (547) agreed that prostate cancer could be cured if detected early, while only 14.9% (109) believed they were unlikely to suffer from prostate cancer. In a logistic regression model, visit to a doctor for (but not presence of) LUTS was a strong, independent predictor of participation in PSA testing (OR 9.0, 95% CI 5.0, 16.0). Beliefs, occupation and education were not. In a similar model examining intention to test, belief in vulnerability to prostate cancer was the strongest predictor (OR 3.32, 95% CI 1.9, 5.9), followed by doctor visit for urinary symptoms. These data are consistent with widespread PSA testing and with seeking treatment for LUTS being a major determinant of previous testing. NHMRC Clinical Guidelines for LUTS recommend against PSA testing for investigation of uncomplicated LUTS. Implementation of those guidelines may therefore have a significant effect on PSA testing rates. Belief in personal vulnerability to prostate cancer remains a significant component of reported future testing, suggesting a focus for community education.

Adult↗
PubMed1997

A specificity comparison of four antisense types: morpholino, 2'-O-methyl RNA, DNA, and phosphorothioate DNA.

Cell-free translation studies were carried out to compare the efficacy and specificity of four antisense structural types: DNA, phosphorothioate DNA (S-DNA), 2'-O-methyl RNA, and Morpholino oligos, a novel antisense structural type. In these studies, translational inhibition was assessed for two 20-mers of each structural type, where one 20-mer was complementary to its target sequence in rabbit alpha-globin mRNA and the other 20-mer contained three mispairs to that same target sequence. It is shown that at low concentration of antisense oligomer (50 nM) all four types provide high specificity, but the Morpholino oligos and 2'-O-methyl RNA afford better efficacy. At high oligomer concentration (3.5 microM), all four types provide high efficacy, but the Morpholino oligos and 2'-O-methyl RNA provide substantially better specificity than the DNA and S-DNA.

Animals↗
PubMed1997

Morpholino antisense oligomers: design, preparation, and properties.

Antisense promised major advances in treating a broad range of intractable diseases, but in recent years progress has been stymied by technical problems, most notably inadequate specificity, ineffective delivery into the proper subcellular compartment, and unpredictable activity within cells. Herein is an overview of the design, preparation, and properties of Morpholino oligos, a novel antisense structural type that solves the sequence specificity problem and provides high and predictable activity in cells. Morpholino oligos also exhibit little or no nonantisense activity, afford good water solubility, are immune to nucleases, and are designed to have low production costs.

Animals↗
PubMed1997

Morpholino and phosphorothioate antisense oligomers compared in cell-free and in-cell systems.

Morpholino and phosphorothioate (S-DNA) antisense oligos were compared in both cell-free and in-cell translation systems. In the most stringent test of specificity in the cell-free system, a globin-targeted S-DNA oligo was found to inhibit its target sequence at concentrations of 10 nM and above, but the sequence-specific component of this inhibition dropped below 50% at concentrations of 100 nM and above. A corresponding Morpholino oligo achieved even higher inhibition at 10 nM, but in contrast to the S-DNA, with the Morpholino, the sequence-specific component of this inhibition remained above 93% at a concentration of 3000 nM. In this same cell-free test system, several S-DNA oligos exhibited substantial undesired nonantisense effects at concentrations of 300 nM and above, whereas corresponding Morpholino oligos exhibited little or no nonantisense activity through a concentration of 3000 nM. In scrape-loaded HeLa cells, both globin-targeted and HBV-targeted S-DNAs (both antisense and control oligos) generally failed to achieve significant translational inhibition at extracellular concentrations up to 3000 nM. In contrast, the Morpholino oligos achieved effective and specific translational inhibition at extracellular concentrations ranging from 30 nM to 3000 nM.

Animals↗
PubMed1997

A systematic review of the effectiveness of promoting lifestyle change in general practice.

BACKGROUND: There is increasing evidence that particular lifestyle behaviours increase the risk of disease and it is widely argued that GPs are ideally placed to encourage patients to modify their behaviour in these areas and thereby reduce their disease risk. There is therefore a need for evidence that GP-based lifestyle interventions are effective in eliciting behaviour change. As there has been no comprehensive attempt to review the literature on this subject, we chose to conduct a systematic review, incorporating meta-analytic techniques where possible, to address this need. OBJECTIVES: This study aimed to examine how effective lifestyle advice provided by GPs is in changing patient behaviour. The following four areas of behaviour were examined: smoking, alcohol consumption, diet, and exercise. METHOD: The review was restricted to English-language reports of trials which investigated the effectiveness of lifestyle advice provided in a general practice setting. Studies were included where it could be established that subjects were randomly allocated to experimental groups and where a comparison was made between either a "no intervention' or "usual care' control group, or between advice of differing intensities. Six electronic databases were searched and a total of 37 trials were selected for inclusion in the review. Meta-analytic techniques were employed to analyse the data from the smoking advice trials. The results form the trials concerned with the other three behaviours did not lend themselves to this form of analysis. Outcome data were extracted from these trials and summarized in tabular form. RESULTS: The results of this review suggest that whilst many of the general practice-based lifestyle interventions show promise in effecting small changes in behaviour, none appears to produce substantial changes. CONCLUSION: There is a need for more extensive and rigorous research in this area before substantial public funds are committed to general practice-based health promotion. Furthermore, it is clear that if general practice-based interventions are to be effective in a public health sense, a greater number of GPs will need to become involved in promoting behaviour change than the literature suggests is currently occurring.

Alcohol Drinking↗
PubMed1997

Functional teams lead to Joint Commission success.

As the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) has shifted the focus of its survey process to the organization as a whole, new techniques are needed to prepare for surveys. Staten Island University Hospital used teams based on the eleven important functions to achieve a successful survey.

Accreditation↗
PubMed1997

Affinity purification of RNA: sequence-specific capture by nonionic morpholino probes.

Nucleic acid isolation for amplification-based diagnostics requires techniques that do not co-purify inhibitors of DNA polymerases. Also, other requirements for an ideal sample preparation technology include ease of use, capability for automation, high recovery and the use of nontoxic reagents. Affinity purification techniques provide high purification factor with minimal sample processing. Hybridization is the affinity interaction specific to nucleic acids and thus provides a uniquely advantageous method for purifying DNA or RNA for subsequent manipulation. Nonionic (morpholino) probes (Neu-Probes, AntiVirals, Corvallis, OR, USA) have several unique hybridization properties, including resistance to nucleases and the ability to hybridize independently of salt concentration. Therefore, such probes provide advantages over DNA probes for sample preparation by hybridization capture. Three formats for hybridization-based purification of human immunodeficiency virus (HIV) RNA were evaluated using RNA transcripts spiked into crude lysates of normal human plasma. Indirect capture used streptavidin-coated microparticles to capture hybrids of biotinylated capture probes and HIV RNA. Direct capture used particles precoated with probes. In addition, a novel method for acceleration of sequence-specific hybridization was developed and shown to give consistently high recoveries.

DNA-Directed DNA Polymerase↗
PubMed1997

Cancer screening in general practice.

Screening for cancer is the focus of increasing interest and activity in general practice. Where clear evidence and guidelines are available, the GP has a key role in the promotion of screening. Where the evidence is inconclusive, GPs are faced with the more difficult task of negotiating screening decisions with their patients which reflect this uncertainty and incorporate patients' preferences. GPs play a central role in cancer screening in Australia, whether or not they actually provide the tests. Critical activities include the provision of information and coordination of the screening process. On-going education and skill development in this area is, therefore, a high priority for Australian GPs.

Australia↗
PubMed1996

Screening for colorectal cancer: a survey of New Zealand general practitioners.

AIM: To determine the attitudes and reported behaviours of New Zealand general practitioners concerning colorectal cancer screening and diagnosis with special consideration of the use of faecal occult blood tests. METHOD: A postal survey of a random sample of 400 New Zealand general practitioners. RESULTS: The response rate to the survey was 63%. Most of the respondents did not support a screening programme for average risk patients but did support screening in high risk groups. General practitioners favoured a screening programme offered by themselves rather than a centrally organised screening programme. A majority of respondents agreed that there was a lack of clear guidelines and a need for education regarding screening for bowel cancer. CONCLUSION: Guidelines for colorectal cancer screening are required for New Zealand general practitioners. There appears to be a need for medical education concerning screening for colorectal cancer in particular and screening and prevention in general.

Adult↗
PubMed1995

Screening for colorectal cancer: what are the costs?

We examined a screening program for colorectal cancer in South Australia in terms of its overall direct costs to society and costs to participants. The best estimate of the cost per cancer detected was $18,924 (Australian dollars). Potential improvements in health outcome through screening are discussed in light of these costs.

Colorectal Neoplasms↗