PubMed Health⌕ Search

Biomedical subjects

I Graham

Publications and source records attributed to I Graham.

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

Vocal recognition in the spotted hyaena and its possible implications regarding the evolution of intelligence.

Spotted hyaenas, Crocuta crocuta, are gregarious carnivores whose social lives share much in common with those of cercopithecine primates. We conducted playback experiments to determine whether free-living hyaenas are capable of identifying individual conspecifics on the basis of their long-distance vocalization, the 'whoop'. When prerecorded cub whoops were played to mothers and other breeding females (controls), mothers responded significantly more vigorously to whoops of their own cubs than did controls. We also tested the hypothesis that specific vocal recognition abilities are based on kinship in this species. Listeners that were related to the whooping cub responded more vigorously to recorded vocalizations than did unrelated individuals, with response intensity in some cases increasing directly with the size of the coefficient of relatedness (r). Our final goal was to determine whether control animals in these experiments can recognize third-party social relationships among other group members, an ability demonstrated by vervet monkeys, Cercopithecus aethiops, in similar playback experiments conducted by earlier investigators. In contrast to vervets, control females in the present experiments were no more likely to look at the mother of the whooping cub than at other control females after playback. This suggests that hyaenas may accomplish many of the same social feats as do vervets without possessing the ability to recognize third-party relationships. If confirmed in other domains of hyaena social life, our findings have important implications regarding selection pressures favouring the evolution of intelligence. Copyright 1999 The Association for the Study of Animal Behaviour.

Journal Article↗
PubMed1999

Investigating and implementing change within the primary health care nursing team.

Primary care is developing rapidly with significant impacts on the nursing team. Such changes have brought inter-professional team-working into sharper focus, particularly community care and collaborative working. This paper: examines the nursing roles within a general practice; describes the perspectives of service users; identifies areas of change; clarifies core and specialist skills; defines new roles among the primary health care nursing team; proposes a new model of working; and identifies appropriate education. The project was set in a general practice in south-west England and used an action research methodology. The objectives were to create a change in practice and to develop and refine existing theory to underpin nursing roles. Throughout the research regular team meetings allowed reflection and discussion about research findings and progress. Data were collected from multiple sources, including team workshops, patient focus group interviews, and individual interviews with GPs, practice managers and area managers. Reflective diaries and a patient survey were also used. The analysis of the quantitative and qualitative data collected from patients formed a basis for practice development and facilitated the team's reflection on the areas of change. Overall high satisfaction with services and care was expressed in the patient interviews and the questionnaire. The themes from the data highlighted areas important for patients and helped in shaping the new roles and responsibilities for team members. Regarding the team perspective, the data indicated many areas that could be considered for development. The community nursing team decided to concentrate on three key areas: child health, leg ulcer management, and cardiovascular health. The research concludes that action research presents some problems and challenges but is a useful approach to developing team-working in primary health care.

Cardiovascular Diseases↗
PubMed1999

Evidence-based medicine and the practicing clinician.

OBJECTIVE: To assess the attitudes of practicing general internists toward evidence-based medicine (EBM-defined as the process of systematically finding, appraising, and using contemporaneous research findings as the basis for clinical decisions) and their perceived barriers to its use. DESIGN: Cross-sectional, self-administered mail questionnaire conducted between June and October 1997. SETTING: Canada. PARTICIPANTS: Questionnaires were sent to all 521 physician members of the Canadian Society of Internal Medicine with Canadian mailing addresses; 296 (60%) of 495 eligible physicians responded. Exclusion of two incomplete surveys resulted in a final sample size of 294. MAIN RESULTS: Mean age of respondents was 46 years, 80% were male, and 52% worked in large urban medical centers. Participants reported using EBM in their clinical practice always (33, 11%), often (173, 59%), sometimes (80, 27%), or rarely/never (8, 3%). There were no significant differences in demographics, training, or practice types or locales on univariate or multivariate analyses between those who reported using EBM often or always and those who did not. Both groups reported high usage of traditional (non-EBM) information sources: clinical experience (93%), review articles (73%), the opinion of colleagues (61%), and textbooks (45%). Only a minority used EBM-related information sources such as primary research studies (45%), clinical practice guidelines (27%), or Cochrane Collaboration Reviews (5%) on a regular basis. Barriers to the use of EBM cited by respondents included lack of relevant evidence (26%), newness of the concept (25%), impracticality for use in day-to-day practice (14%), and negative impact on traditional medical skills and "the art of medicine" (11%). Less than half of respondents were confident in basic skills of EBM such as conducting a literature search (46%) or evaluating the methodology of published studies (34%). However, respondents demonstrated a high level of interest in further education about these tasks. CONCLUSIONS: The likelihood that physicians will incorporate EBM into their practice cannot be predicted by any demographic or practice-related factors. Even those physicians who are most enthusiastic about EBM rely more on traditional information sources than EBM-related sources. The most important barriers to increased use of EBM by practicing clinicians appear to be lack of knowledge and familiarity with the basic skills, rather than skepticism about the concept.

Adult↗
PubMed1999

Plasma homocysteine as a cardiovascular risk factor: causal, consequential, or of no consequence?

Elevated plasma total homocysteine may be causally related to the risk of atherosclerotic cardio-vascular diseases. Many significant studies indicate an effect by elevated homocysteine on cardiovascular disease occurrence, progression, and recurrence that is independent of traditional risk factors. However, recent data have cast doubt on the veracity of the relationship between elevated plasma total homocysteine and the incidence of cardiovascular disease. In general, a stronger relationship has been found in cross-sectional and retrospective case-control studies than in nested case-control or prospective studies. The issues of study design, bias, and confounding are critical to an analysis of this putative relationship, and their effects can only be avoided by randomized controlled trials of homocysteine-lowering therapy (folic acid). While awaiting the outcome of these trials, there may already be sufficient evidence to prescribe homocysteine-lowering therapy in subjects deemed to be at high risk of cardiovascular disease.

Aged↗
PubMed1998

Low circulating folate and vitamin B6 concentrations: risk factors for stroke, peripheral vascular disease, and coronary artery disease. European COMAC Group.

BACKGROUND: A high plasma homocysteine concentration is a risk factor for atherosclerosis, and circulating concentrations of homocysteine are related to levels of folate and vitamin B6. This study was performed to explore the interrelationships between homocysteine, B vitamins, and vascular diseases and to evaluate the role of these vitamins as risk factors for atherosclerosis. METHODS: In a multicenter case-control study in Europe, 750 patients with documented vascular disease and 800 control subjects frequency-matched for age and sex were compared. Plasma levels of total homocysteine (before and after methionine loading) were determined, as were those of red cell folate, vitamin B12, and vitamin B6. RESULTS: In a conditional logistic regression model, homocysteine concentrations greater than the 80th percentile for control subjects either fasting (12.1 micromol/L) or after a methionine load (38.0 micromol/L) were associated with an elevated risk of vascular disease independent of all traditional risk factors. In addition, concentrations of red cell folate below the lowest 10th percentile (<513 nmol/L) and concentrations of vitamin B6 below the lowest 20th percentile (<23.3 nmol/L) for control subjects were also associated with increased risk. This risk was independent of conventional risk factors and for folate was explained in part by increased homocysteine levels. In contrast, the relationship between vitamin B6 and atherosclerosis was independent of homocysteine levels both before and after methionine loading. CONCLUSIONS: Lower levels of folate and vitamin B6 confer an increased risk of atherosclerosis. Clinical trials are now required to evaluate the effect of treatment with these vitamins in the primary and secondary prevention of vascular diseases.

Adult↗
PubMed1998

A prospective endoscopic study of scalloped folds and grooves in the mucosa of the duodenum as signs of villous atrophy.

BACKGROUND: Scalloping of the valvulae conniventes visible at endoscopy may predict the presence of villous atrophy. This prospective study was designed to discover how commonly duodenal mucosal scallops and grooves occurred and to delineate their relationship to villous atrophy. METHODS: All patients undergoing upper gastrointestinal endoscopy by a single observer over 5 years were included. After inspection of the duodenal mucosa, biopsy samples were taken from those in whom the mucosa was abnormal (n = 26) and from those in whom it was not, but where biopsy was indicated (n = 100). RESULTS: None of the 100 endoscopically normal controls had subtotal villous atrophy: 94 had normal histology, 2 had non-atrophic change, and 4 had partial villous atrophy; 14 of the 26 individuals (54%) with abnormal duodena had subtotal villous atrophy, 7 having both scallops and grooves. Four had scallops alone, and three had grooves only. All patients with both scallops and grooves had subtotal villous atrophy (100%), the positive predictive value of which was 36% for scallops alone and 38% for grooves alone. CONCLUSIONS: Scallops and grooves together indicate that subtotal villous atrophy is very likely histologically, even when that diagnosis has not been suspected. A normal duodenum excludes it.

Adult↗
PubMed1998

A decision aid for women considering hormone therapy after menopause: decision support framework and evaluation.

Although postmenopausal women are advised to consider their values when deliberating about potential benefits and risks of hormone therapy (HRT), feasible, effective methods of decision support in primary care have yet to be established. Using an explicit decision support framework, we developed a self-administered HRT decision aid and evaluated it in a before/after study of 94 women from six family practices. An audiotape guided women through an illustrated booklet including: detailed information about HRT benefits and risks tailored to a woman's clinical risk, and a values clarification exercise to promote informed decision making consistent with personal values. After using the decision aid participants: had better general knowledge and more realistic personal expectations of HRT benefits and risks; and, felt more certain, informed, clear about values, and supported in decision making. Women's values elicited in the clarification exercise were 84% accurate in discriminating between decisions. Women with polarized preferences at baseline did not change their minds, but were better informed. Changes in preferences occurred in the uncertain group, with equal numbers accepting or declining HRT. Most participants found the decision aid comprehensible, acceptable in length and pace, and balanced. Decision aids are useful in preparing women for decision making about this complex, personal issue.

Aged↗
PubMed1997

Lung cancer practice guidelines: lessons learned and issues addressed by the Ontario Lung Cancer Disease Site Group.

PURPOSE: The primary objective was to identify the lessons learned and issues addressed by the Disease Site Group (DSG) developing guidelines on lung cancer for practitioners in the province of Ontario. METHODS: The minutes of the Ontario Lung Cancer Disease Site Group (LCDSG) and the meeting notes of a medical sociologist who attended all LCDSG meetings were reviewed to identify the disease-specific and generic issues addressed by the LCDSG during guideline development. RESULTS AND CONCLUSION: The Ontario LCDSG has completed three practice guidelines and has five evidence-based recommendations (EBRs) in production. Topics for guideline development were selected on the basis of known practice variability (eg, advanced-stage non-small-cell lung cancer [NSCLC]); the size of the patient population that could potentially be affected by the guideline; results of phase II trials of new and potentially expensive agents (vinorelbine, paclitaxel, and docetaxel); and randomized controlled clinical trials that support new practice standards (combined modality therapy for unresectable stage III NSCLC). The wording of each EBR reflects the strength and quality of the evidence in support of the treatment option, the primary outcome(s), and the individual physician and discipline values concerning treatment outcomes in the absence of known patient values.

Canada↗
PubMed1996

A presentation of a conceptual framework and its use in the definition of nursing development within a number of nursing development units.

This paper provides a conceptual framework upon which action plans can be built to enable registered nurses to reflect upon their work and practice activities. This conceptual framework has been used by the author in his work with various nursing development units within Yorkshire, England, in his role as their academic nurse advisor. The framework has been useful in helping nurses not only to reflect upon current work and practice activities but also as a guideline for future development. The paper provides examples of such nursing development activities and includes a personal view of how nursing development units can act as catalysts for change.

Clinical Nursing Research↗