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Biomedical subjects

J Clifford

Publications and source records attributed to J Clifford.

33 records · Page 2Linked to original sources
PubMed1995

What do experienced GPs really need in communication skills training?

In studying the connections between the verbal interactions in general practice consultations and outcomes such as patient and doctor satisfaction, the authors developed an interest in the various sources of occupational stress for Australian GPs. Doctors and their patients do not necessarily agree about how satisfactory a consultation was, raising questions about whose definition of quality in medical care should prevail. Doctors' concerns about exceeding the Health Insurance Commission (HIC) norms for frequency and length of consultations seemed to inhibit them from providing the listening time some patients need. Complexity of consultations proved difficult to rate reliably. Experienced GPs in a preceptor role expressed mixed feelings about the value of communication skills training compared with changes in remuneration policies. We seek comment from readers about these observations.

Communication↗
PubMed1994

RAR beta isoforms: distinct transcriptional control by retinoic acid and specific spatial patterns of promoter activity during mouse embryonic development.

That both deficiency and excess of vitamin A lead to a wide spectrum of congenital abnormalities has strongly implicated the active metabolite, retinoic acid (RA), in normal embryonic development. There are 3 families of RA receptors (RARs), RAR alpha, RAR beta and RAR gamma, each having at least two isoforms derived from primary transcripts initiated at two promoters P1 and P2 (reviewed in Leid et al., 1992) Transcripts encoding all 4 isoforms of RAR beta (RAR beta 1 to RAR beta 4) accumulate in embryonal carcinoma (EC) cells in the presence of RA. It has been previously shown that the RA modulation of RAR beta 2/beta 4 transcripts is achieved at the level of transcriptional initiation via a RA response element (RARE) present in the P2 RAR beta 2/beta 4 promoter. In contrast, the mechanism by which RA up-regulates RAR beta 1/beta 3 transcripts has not yet been elucidated. We describe here the isolation of the P1 RAR beta 1/beta 3 promoter and characterization of its activity in transgenic animals. We find that RAR beta 1/beta 3 promoter activity, which is apparently confined to the embryonic CNS, is not modified by RA treatment, unlike that of the RAR beta 2/beta 4 promoter (Mendelsohn et al., 1991). Nuclear run-on transcription analysis in EC cells supports the conclusion that RAR beta 1/beta 3 transcript initiation is not modulated by RA, and that the RA-induced accumulation of RAR beta 1/beta 3 transcripts occur via a RA-dependent release of a block in RNA chain elongation.

Animals↗
PubMed1994

Sources of occupational stress for Australian GPs, and their implications for postgraduate training.

Following a study of process and outcomes in general practice consultations, we returned to the GP participants and asked them to comment on taped consultations which they had found unsatisfying. Their comments were then analysed for information about sources of occupational stress, coping strategies, and this method of self-monitoring. About two-thirds of the stressors which they described arose from their interaction with the patient, and the rest from sources either internal to the doctor or else external to the particular doctor and consultation. The subjects' comments about their coping techniques, and their acceptance of this method of self-monitoring, in conjunction with the findings about sources of occupational stress provide a basis for planning vocational education in general practice.

Adaptation, Psychological↗
PubMed1992

Determining medical necessity of outpatient physical therapy services.

A patient referred for physical therapy may attend one or several therapy visits or may continue to receive ongoing therapy services several times weekly for several months. The question of the continued medical necessity of those services arises often. Determination of medical necessity for continued therapy services requires knowledge of the natural history of diseases that may require therapy services, familiarity with the effectiveness of treatment alternatives for those diseases, and awareness of community practice patterns. Accurate and complete documentation from the therapist or referring physician is required for the physician advisor or utilization review consultant to make an accurate determination of medical necessity. A structured format for providing this documentation is suggested.

Adult↗
PubMed1986

Age-associated changes in the circadian rhythm of retinal N-acetylserotonin and melatonin in rats with pigmented eyes.

Using a semiquantitative immunohistochemical procedure, we have evaluated the 24 hour circadian rhythm of N-acetylserotonin- and melatonin-like immunoreactivity in the retina of male hooded rats that have pigmented eyes. Three and twenty months old Long Evans rats were used. Animals were kept under a 14 light (L): 10 dark (D) lighting cycle and were sacrificed during the month of June. Four time points were assessed in the 24 hour light/dark cycle. Retinal N-acetylserotonin and melatonin were assessed by immunohistochemistry and microphotometric procedures as previously used by us. In young animals, the intensity of retinal N-acetylserotonin and melatonin immunofluorescence was significantly different (P less than 0.005, DF = 17) in animals killed during the light vs the dark period with peak values during the dark period. In contrast, retinal N-acetylserotonin and melatonin-immunofluorescence in old animals showed a flattened 24 hour rhythm, with light values as high as those observed during the dark period. The age-associated bluntness of the 24 hour rhythm was more noticeable for N-acetylserotonin than for melatonin immunofluorescence.

Aging↗
PubMed1981

The effect of fenclofenac on thyroid function.

The non-steroidal anti-inflammatory agent fenclofenac competitively inhibits the binding of thyroxine(T4) and triiodothyronine (T3) by thyroxine-binding globulin(TBG). Eight male volunteers completed a 4-week study during which they took fenclofenac 600 mg twice daily. The concentration of fenclofenac in serum reached a plateau after 1 week of therapy after which the mean concentration(+/SEM) of the drug in serum was 78.6 o.2 mg/1. During the steady state period on treatment there were reductions of the mean serum concentrations of total T4 to 35% (P less than 0.001), total T3 to 55% (P less than 0.001), free T4 to 69% (P less than 0.001) and free T3 to 90% (NS) of the respective pretreatment values. There were also significant changes in the concentrations of thyrotropin and reverse T3 in serum. After starting treatment with fenclofenac serum concentrations of thyrotrophin fell to a nadir after 2-4 days at which time the mean concentration was 34% (P less than 0.01) of the pretreatment value, whilst reverse T3 values increased to a maximum of 136% (P less than 0.001) of the pretreatment values over 1-2 days. There was subsequently an increase of the thyrotrophin and a reduction in reverse T3 concentrations to normal by 2 weeks of pretreatment. Transient pituitary suppression was also suggested by the response to to thryotrophin-releasing hormone (TRH): 7 days after starting fenclofenac the mean thyrotrophin response was 62% (P less than 9.001) of the pretreatment value. After 4 weeks of fenclofenac the response of TRH had returned to normal. After discontinuing fenclofenac there was a transient increase in the mean concentration of thyrotrophin in serum, to 129% of the pretreatment value (P less than 0.001), with a subsequent return to normal. Four weeks after discontinuing fenclofenac the serum concentrations of thyroid hormones and thyrotrophin were normal.

Adult↗
PubMed1978

The effects of surfactants on cell aggregation.

Trypsin-dissociated HeLa and human amnion cells were employed to investigate the effects of an anionic, a cationic, and a non-ionic surfactant on cell reaggregation. All the surfactants inhibited the reaggregation process, the effect increasing with surfactant concentration, and becoming significant at concentrations of about 10(-6) M for the anionic surfactant and about 10(-5) M for the others. The effects of temperature and ionic strength on HeLa cell aggregation, and of surfactants on the electrophoretic mobility of HeLa cells and the release of sialic acid from their surfaces by neuraminidase, were also examined. The results indicate that although electrostatic effects occur and are likely to be of importance in cell reaggregation, the effect of surfactants cannot be accounted for on this basis alone, and it is suggested that interactions involving the cell-surface glycoproteins, possibly indirectly via effects on the fluidity of the cell membrane, are also significant in this respect.

Cell Aggregation↗