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Biomedical subjects

J Kai

Publications and source records attributed to J Kai.

At least 19 recordsLinked to original sources
PubMed2001

" 'Just think of TB and Asians', that's all I ever hear": medical learners' views about training to work in an ethnically diverse society.

UNLABELLED: The case for being able to respond effectively to cultural and ethnic diversity in health care is attracting increasing debate in medical education. However research exploring the perspectives of learners is lacking. AIMS: We sought medical learners' perceptions and their perceived training needs in relation to cultural and ethnic diversity in health care. METHODS: A series of nine focus group interviews was conducted with 55 medical learners, including undergraduate students in a UK medical school and a group of postgraduate general practitioners in training. Interview data were analysed using qualitative methods. RESULTS: Participants had a broad but superficial awareness of multicultural issues. This focused upon "difference" with students emphasizing their need to acquire knowledge of different beliefs and practices. Current teaching was perceived as inadequate and limited largely to ethnic patterns of disease. Most felt a need for greater training. They regarded development of particular communication skills, such as working with interpreters as helpful. Beyond avoiding stereotyping, learners rarely identified reflecting upon their attitudes or the issue of racism as important. Students anticipated a range of potential problems for further training, but sought learning that was relevant, practically oriented and stimulating. CONCLUSIONS: The study points to learners' experience of inadequate training but suggests a willingness to learn more. The possible predominance of a "difference" perspective might drive a narrow focus upon learning cultural knowledge at the expense of promoting a balance with self-reflection upon attitudes and developing generic skills. Educators might heed learners' views about how they should be taught successfully.

Attitude of Health Personnel↗
PubMed2001

Cross-cultural communication in medicine: questions for educators.

Most research into medical communication has had a western setting. It has been undertaken by western researchers and been influential in shaping communication skills curricula. However we know much less about what communication is effective under other circumstances. This article highlights gaps in our knowledge from research in this field, and poses attendant questions for debate by medical educators. We consider the following key aspects of debate on cross-cultural work. (i) To what extent can our understanding of general principles in other cultures be summarized and presented for teaching in a way which does not descend into caricature? Alternatively, can features of other cultures be presented in ways which do not descend into particularity? (ii) Can such paradigms as "patient-centredness" be transferred from culture to culture? Should they be presented across cultures as features of "good" consultations? (iii) What use can be made of the role of interpreters for teaching purposes? What importance does it have to the educator that a doctor may not be a native speaker of the majority language of the culture in which s/he is operating? (iv) Although the language of illness, and particularly metaphors associated with illness, are studied in other cultures, the way in which illness is metaphorized in British English is seldom discussed. What can educators learn and teach from a study of such matters? (v) What are the implications for communication skills teachers of the need to present materials within a culturally diverse environment?

Attitude of Health Personnel↗
PubMed2001

Wrestling with ethnic diversity: toward empowering health educators.

UNLABELLED: The importance of training health professionals for work in an ethnically diverse society is increasingly recognized. However, health educators may lack confidence or experience in delivering such teaching, contributing to a self-perpetuating inertia. OBJECTIVES: To identify current experience and challenges perceived by educators of different health professionals, and to facilitate and debate the development of teaching in this field. METHODS: Educators (n=61) from 42 different organizations, participated in facilitated workshops in three different UK settings. They included clinician teachers of medical undergraduates and postgraduates, and educators of nurses, primary care and hospital physicians, physiotherapists, occupational therapists and paramedical staff. Opportunities were provided for educators to discuss experiences; to participate as "learners" in examples of interactive training exercises; to anticipate challenges they might encounter in developing and providing training themselves; and to discuss ways of negotiating them. Qualitative data generated from the workshops were analysed for common themes. RESULTS: Participants had received little relevant training themselves. For many, the workshops provided a first formal opportunity to consider their own responses to ethnic diversity in health care. Current provision of such training in their institutions was limited. Educators lacked specific training to facilitate the learning of others in this field. They wrestled with a wide range of issues: from critical dilemmas about the philosophy of teaching, through to the practicalities and personal challenges of face to face teaching. Strategies to address these were generated that may merit consideration. CONCLUSION: Educators will need help to overcome their uncertainty in approaching this topic and be empowered to develop training. Developing teachers' own awareness and skills, followed by appropriate support, are likely to be prerequisites for successful training.

Cultural Diversity↗
PubMed2001

Perspectives of people with enduring mental ill health from a community-based qualitative study.

BACKGROUND: The views of people with enduring mental ill health have received limited exploration. Existing work has largely focused on patients in specialist mental health settings, rather than on a wider range of patients in the community. AIM: To explore experiences and perceptions of health care of people with enduring mental ill health. DESIGN OF STUDY: A community-based qualitative study using theoretical sampling, in-depth interviews, and grounded methodology. SETTING: A total of 34 responders registered with four general practices, serving five wards with a mean Townsend Deprivation Score of 7.75. METHOD: Subjects were chosen using a theoretical sampling framework and they participated in one-to-one interviews which were audiotaped. Themes were identified and developed by reading transcripts, then they were further refined and classified manually by open coding into key categories using a grounded approach. RESULTS: The primary goal of the responders was to enhance, sustain, and take control of their mental health. The building of positive therapeutic relationships with professionals based upon effective communication, trust, and continuity were important to achieving this aim. However, the settings in which their health care took place could affect responders' attempts to deal with social stigma. Experiences of social isolation, socioeconomic privation, and stigmatisation were often pervasive. These compromised responders' opportunities and their capacity to enhance their mental health, compounding their illness and marginalisation. CONCLUSIONS: This study shows the potential of health professionals to empower people with enduring mental ill health, by attending to the quality of communication and continuity of care they provide and to where this takes place. It further underlines a need to address the social stigma and exclusion this group experiences.

Adult↗
PubMed2000

Prevalence of enduring and disabling mental illness in the inner city.

Previous research identifying the long-term mentally ill in primary care has been outside areas of deprivation. We used a case finding approach by a primary care group to identify the prevalence and characteristics of people with enduring and disabling mental ill health in a disadvantaged inner-city community. We found a high point prevalence (12.9 per 1000 patients) of enduring psychotic and non-psychotic illness (36.1% and 63.9% respectively). This contributed to considerable workload and disability, and included a significant proportion of older people (24.6% aged over 65 years). The approach may be useful for local needs assessment. It highlights a need to consider disability as well as diagnosis for service development.

Adolescent↗
PubMed2000

Presentation with influenza-like illness in general practice: implications for use of neuraminidase inhibitors.

General practitioners in the Midlands Research Practice Consortium (MidReC), combined list size 140,000, completed questionnaires about 918 patients in whom they had made working diagnoses of influenza-like illness during an outbreak of influenza A H3N2 from 1 December 1999 to 4 February 2000. Adults, more females than males consulted most, reflecting the age and sex distribution reported to the Royal College of General Practitioners Weekly Returns Service. Illness at presentation was considered severe in 4%, moderately severe in 49%, mild in 45%, and asymptomatic (for example, attended for certificates) in 1% of patients. In seven tenths of patients, the practitioner estimated that the likelihood of influenza was 70% or more and in just over half, 80% or more. Half of patients aged over 75 years were seen at home, but only 7% of those under 55 years. Less than a quarter of patients consulted within two days of having become ill, with the highest consultation frequency on the third and fourth days. Preschool children presented earliest: 75% were seen within two days, compared with only 17% of adults over 75 years. Four fifths of patients were seen on the same day as they contacted the practice, and 12% on the following day. Given the brief time window for effective antiviral treatment, only a small proportion of patients are likely to be prescribed these drugs unless consulting behaviour, especially in elderly people, changes considerably.

Adolescent↗
PubMed1999

Antibacterial action of bile acids against Helicobacter pylori and changes in its ultrastructural morphology: effect of unconjugated dihydroxy bile acid.

Although it has been shown that bile acids possess antibacterial activity against Helicobacter pylori, few reports on their activity have been published. We determined the minimum inhibitory concentration at 72 h of various unconjugated and conjugated bile acids against laboratory standard strains and clinical isolates of H. pylori, and studied morphologic changes of H. pylori under the scanning electron microscope during treatment with deoxycholic acid and ursodeoxycholic acid at the minimum inhibitory concentrations for 24 h. We found that only the unconjugated form of dihydroxy bile acid has antibacterial activity. The minimum inhibitory concentration of deoxycholic acid is 200-400 microg/ml, that of chenodeoxycholic acid is similar to that of deoxycholic acid, and that of ursodeoxycholic acid is 400-800 microg/ml. The morphology of H. pylori changed from its primary rodlike shape to a spherical shape with blebs on the cell surface, and was further degraded to an irregularly condensed mass, following an increase in bile acid. This morphologic change in H. pylori was different from the change to a spherical shape caused by amoxicillin. On the basis of these results, it seems that unconjugated dihydroxy bile acid might be a candidate drug for eradication of H. pylori, but further investigations of the clinical usefulness of bile acid for this purpose should be done.

Bile Acids and Salts↗
PubMed1999

Learning to value ethnic diversity--what, why and how?

INTRODUCTION: Learning to value ethnic diversity is the appreciation of how variations in culture and background may affect health care. It involves acknowledging and responding to an individual's culture in its broadest sense. This requires learning the skills to negotiate effective communication, a heightened awareness of one's own attitudes, and sensitivity, to issues of stereotyping, prejudice and racism. This paper aims to contribute to debate about some of the key issues that learning to value ethnic diversity creates. CONTEXT: Although some medical training is beginning to prepare doctors to work in an ethnically diverse society, there is a long way to go. Promoting 'valuing ethnic diversity' in curricula raises challenges and the need to manage change, but there are increasing opportunities within the changing context of medical education. Appropriate training can inform attitudes and yield refinement of learners' core skills that are generic and transferable to most health encounters. CURRICULUM DEVELOPMENT: Care must be taken to avoid a narrow focus upon cultural differences alone. Learning should also promote examination of learners' own attitudes and their appreciation of structural influences upon health and health care, such as racism and socio-economic disadvantage. Appropriate training and support for teachers are required and learning must be explicitly linked to assessment and professional accreditation. CONCLUSION: Greater debate about theoretical approaches, and much further experience of developing, implementing and evaluating effective training in this area are needed. Medical educators may need to overcome discomfort in developing such approaches and learn from experience.

Culture↗
PubMed1998

Comparison between in vivo mutagenicity and carcinogenicity in multiple organs by benzo[a]pyrene in the lacZ transgenic mouse (Muta Mouse).

To evaluate whether the in vivo mutagenicity test system using the lacZ transgenic mice (Muta Mouse) may be applied to carcinogenesis studies, both the in vivo mutagenicity and carcinogenicity of benzo[a]pyrene (BP) was tested in mice under the same administration conditions. The eleven organs of the mice on the 14th day after the final oral administration of BP at a dose of 125 mg kg(-1) day(-1) or corn oil for 5 consecutive days were tested for in vivo mutation by the positive-selection method. The data show that the colon had the highest lacZ mutant frequency (37-fold increase over the spontaneous frequency), followed by the ileum > forestomach > bone marrow, spleen > glandular stomach > liver, lung > kidney and heart. No significant mutations were found in the brain. These results may suggest that, in general, the organs with rapidly proliferative tissues have a marked increase in vivo mutant frequencies under the conditions of this experimental design. The forestomach and lymphatic organs including the spleen (malignant lymphoma) were the main target organs for BP carcinogenesis by 5 daily oral doses of 75 and 125 mg kg(-1) day(-1). These results suggest that the mutation results from the transgenic assay with BP reflect the carcinogenicity of BP in the mouse. They also indicate, however, that the magnitude of the in vivo lacZ mutant frequencies induced by BP in different organs did not fully correlate with the target organs for carcinogenicity.

Animals↗
PubMed1998

Optical high-precision three-dimensional position measurement system suitable for head motion tracking in frameless stereotactic radiosurgery.

Head motion is a significant source of therapy-effect degradation in frameless stereotactic radiosurgery (SRS). In this study, a three-dimensional (3-D) optical head motion measurement system and a coordinate transformation algorithm were used to track patient head motion. With this system, head motion in frameless SRS was carefully investigated with a precision of < 0.1 mm. Head motions without any restraint (three cases) and with a Laitinen adapter (four cases) were measured with a data sampling rate of once per second for 30 min. Positions of IR light emission diode markers attached to the head were analyzed by two statistical methods. From these data, mathematically simulated head motions were obtained in each of the three coordinate directions for nonrestraint and Laitinen-adapter SRS. The results show that segmenting a frameless SRS procedure into a sequence of short intervals and repeating registration of the target position for each interval is a good strategy for better therapy precision. This optical 3-D position measurement system is suitable for high-precision head motion tracking in frameless SRS.

Adult↗
PubMed1998

'They think they can talk to nurses': practice nurses' views of their roles in caring for mental health problems.

BACKGROUND: Primary care teams have been encouraged to develop the care they provide to patients with mental health problems, and a greater role for practice nurses has been advocated. However, little is known about practice nurses' current level of involvement or their perceived strengths and limitations in caring for patients' mental health problems. AIM: To describe practice nurses' current experiences of caring for patients with mental health problems and to explore their perceptions about enlarging this role. METHOD: Pilot interviews were carried out with a purposeful sample of practice nurses to design a postal questionnaire, which was then sent to 635 practice nurses identified from family health services authority lists in six health authorities in the north-east of England. RESULTS: Completed questionnaires were returned by 445 (70%) practice nurses. Most nurses (83%) reported that they commonly saw patients with a range of mental health problems arising indirectly or directly in consultations. Many practice nurses (52%) lacked any formal mental health training and identified a broad range of training needs. A majority (80%) of responders had concerns about their abilities to address mental health problems effectively, given their existing workloads. However, most (61%) were keen to expand their role in mental health care if appropriate support and training were forthcoming. CONCLUSION: There is considerable potential for practice nurses to realize a greater and more effective role in the care of mental health problems in primary care. Developing practice nurses' contribution will require further training and support.

Community Mental Health Services↗
PubMed1996

What worries parents when their preschool children are acutely ill, and why: a qualitative study.

OBJECTIVE: To identify and explore parents' concerns when young children become acutely ill. DESIGN: Qualitative study making use of semi-structured one to one and group interviews with parents of preschool children. SETTING: Disadvantaged inner city community. SUBJECTS: 95 parents of preschool children. RESULTS: Fever, cough, and the possibility of meningitis were parents' primary concerns when their children became acutely ill. Parents' concerns reflected lay beliefs, their interpretation of medical knowledge, and their fears that their child might die or be permanently harmed. Parents worried about failing to recognise a serious problem. Concerns were expressed within the context of keenly felt pressure, emphasising parents' responsibility to protect their child from harm. They were grounded in two linked factors: parents' sense of personal control when faced with illness in their child and the perceived threat posed by an illness. CONCLUSIONS: Better understanding of parents' concerns may promote effective communication between health professionals and parents. Modification of parents' personal control and perceived threat using appropriate information and education that acknowledge and address their concerns may be a means of empowering parents.

Acute Disease↗
PubMed1996

Parents' difficulties and information needs in coping with acute illness in preschool children: a qualitative study.

OBJECTIVES: To identify and explore difficulties parents experience with acute illness in young children and the information they seek to help them. DESIGN: Qualitative study using semi-structured one t one and group interviews with parents of preschool children. SETTING: Disadvantaged inner city community. SUBJECTS: 95 parents of preschool children. RESULTS: Parents felt disempowered when dealing with acute illness in their children because of difficulties making sense of the illness. Central to parents' difficulties were their experiences of inadequate information sharing by their general practitioners and variations in their doctors' decisions and behaviour. Disparity between parents' beliefs and expectations about illness and treatment and professionals' behaviour further frustrated parents' attempts to understand illness. Parents expressed a need for a range of accessible and specific information to support them through their negotiation of children's illness. CONCLUSIONS: Communication with parents requires greater recognition of parents' difficulties. Professionals have considerable potential to empower parents by sharing more information and skills. Such information should be consistent and address parents' concerns, beliefs, and expressed needs if this potential is to be realised.

Acute Disease↗