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Biomedical subjects

J M Lockyer

Publications and source records attributed to J M Lockyer.

34 records · Page 2Linked to original sources
PubMed1991

Effect of educational program and interview on adoption of guidelines for the management of neonatal hyperbilirubinemia.

OBJECTIVES: To determine (a) whether physicians are adhering to the guidelines for the management of neonatal hyperbilirubinemia, (b) what influences their decisions to investigate and treat the condition and (c) the effect of an educational program and clinical recall interview on compliance with the guidelines. DESIGN: Retrospective chart audit. SETTING: Urban tertiary care hospital. PARTICIPANTS: All term neonates who received phototherapy but were not admitted to the neonatal intensive care unit. INTERVENTIONS: Educational program and clinical recall interview. MEASURES: Charts were reviewed from March to May 1986 (period I, before publication of the guidelines) and from November 1986 to January 1987 (period II, after publication and after the educational program). The audits were repeated from April to June 1989 (period III, during the interview phase) and from October to December 1989 (period IV, 6 months after the interviews). Two criteria determined the appropriate use of phototherapy: the serum bilirubin level and the postnatal day on which phototherapy was started. RESULTS: The proportion of infants receiving phototherapy for whom there were orders for complete blood counts to investigate hyperbilirubinemia increased from 20% in period I to 37% in period IV. The frequency of orders to determine the proportion of reticulocytes did not change significantly. The number of infants receiving phototherapy decreased over the study periods. The proportion receiving phototherapy in accordance with the criteria for the serum bilirubin level increased from 10% to 17% after the educational program (insignificant difference) and to 31% after the interviews (p = 0.02). Compliance with the guidelines was greater before the infants were 2 days old than when they were 3 days old or more (p = 0.01). Of the 45 physicians who prescribed phototherapy (for 94 infants) during period IV 26 never prescribed in accordance with the guidelines. The other 19 prescribed in accordance with the guidelines for 30 of 52 infants. Decisions to investigate and treat with phototherapy were affected by clinical and parental factors in addition to the guidelines. Two of the 25 physicians interviewed stated that the interview would influence their management of future cases of hyperbilirubinemia. CONCLUSION: A clinical recall interview can have a greater impact on changing physician management practices than factual communication on a group basis.

Attitude of Health Personnel↗
PubMed1991

Responses to non-emergency questions in rural medicine: their usefulness to practice decisions.

This study reports the nature of non-emergency, day-to-day practice-related questions which arose in rural practice and were phoned in to a medical information system (MIS). The usefulness of these questions, and their responses, to clinical decision-making is outlined. Sixty-seven practitioners from 10 rural communities enrolled in the project. In response to each inquiry two or three articles were sent to the practitioner and to a consultant for validation. At the conclusion of the study the questions posed, and their responses, were examined. Forty-six per cent of the questions received were categorized as diagnostic; 30% as management; and 24% as therapeutic. Questions were classified using the ICD.9.CM. Those most frequently posed were in the nervous system/sense organs (13%), injury/poisoning (9%), and genito-urinary (9%) categories. Interviews with doctors and consultants were conducted to assess the usefulness of the service. Study findings suggest that an MIS can provide helpful information for improving daily aspects of clinical care, doctor-patient communication, administrative decision-making, and physician education. Practitioners, consultants, and medical librarians reported benefits from this service.

Canada↗
PubMed1990

A medical information networking system between practitioners and academia.

This paper reports on a one-year experience with an information networking system (MIS) between 47 rural practitioners and an academic center. Physicians were invited to phone in non-emergency clinical questions specific to daily practice needs to a telephone answering service located in the medical school library. Two-hundred-forty questions triggered by patient visits, colleagues, local rounds, allied health or local professionals, and on-site administrative meetings were forwarded to the MIS. All inquiries were classified according to the International Classification of Disease-9th Revision-Clinical Modification, and categorized into three areas of practice: diagnostic/investigative, general treatment, and pharmacology (therapeutics). The paper outlines how specific practice questions are being screened and adopted for decisions relating to four current activities which assist the ongoing maintenance of competence: 1) CME program planning, 2) residency/undergraduate curriculum development, 3) individualized CME for specific practitioners and sites, and 4) future CME research. The physician inquiries represent true needs in rural medical practice and as such should be given high priority in programs and assessments addressing the maintenance of competence.

Academic Medical Centers↗
PubMed1990

Evaluation of a program to train Saudi Arabian physicians.

The authors evaluated a program at the University of Calgary, in Alberta, Canada, that provided residency training for 11 Saudi Arabian physicians. Through a series of semistructured meetings in 1989 involving the Saudi residents, other residents in the program, members of residency training committees, faculty, and program directors, the program was reviewed to assess whether the Saudi physicians were prepared for the program and progressed satisfactorily when compared with the other residents, whether the training and evaluation were equivalent to those of the other residents, the advantages of the program to the university, and whether the university should be pursuing opportunities to train other foreign nationals. The interviews showed that there was variability in the preparation and progress made by the Saudi residents but the benefits to the university in providing training to a small group of carefully selected foreign-trained physicians were greater than the disadvantages. The information gained during the review reinforced the need to do periodic examinations of training opportunities for foreign physicians and yielded recommendations for improving such training.

Alberta↗
PubMed1988

Family physician registration at locally produced short courses.

Physicians who do not take advantage of short courses that are offered within their community may miss the opportunity to learn about new services and consultants as well as to validate new information or practices with trusted colleagues. The registration patterns at short courses of all 505 family physicians in Calgary were assessed to determine whether the sociodemographic characteristics of attendees differed from those of nonattendees and whether the sociodemographic data were predictive of attendance or nonattendance. Four variables were predictive of attendance or nonattendance: certification status with the College of Family Physicians of Canada (CFPC), year of graduation, sex and hospital affiliation. Physicians who had attended four or more courses were more likely to be graduates of Canadian or US schools, to have graduated after 1969, and to be women, certificants of the CFPC and affiliated with a hospital. Universities, hospitals and professional associations planning continuing education must determine if the needs of nonattending physicians are being met through other means or if new strategies are required to ensure that these physicians have opportunities for upgrading their knowledge. Practitioners who frequently attend short courses can help planners ensure that programming is relevant.

Alberta↗
PubMed1987

Nurses' perceptions of inter- and intra-professional relationships: an analysis of support from nursing and physician colleagues in rural hospitals.

Nurses employed in ten rural hospitals in Canada completed questionnaires designed to examine their perceptions of the strength of the professional relationship which existed among nurses and between nurses and physicians. Four questions addressed the availability of nursing education programs and the attendance of nurses and physicians at such programs. Seven questions examined the nurses' perception of physician interest in nursing education and the encouragement received from their nursing colleagues to participate in learning activities and medical management decision making. Chi square analysis was undertaken to determine whether the colleagial relationships differed by hospital or medical staff characteristics. Forty percent of the nurses felt that the majority of of physicians were supportive of continuing nursing education. Sixty-three percent indicated their nursing colleagues encouraged them to attend educational programs. The results indicate that physician participation in nursing continuing education was greatest in communities with the fewest health resources (an acute hospital with fewer than 50 beds). In contrast, encouragement to participate in continuing nursing education was highest in settings where the hospital provided both acute and extended care services, had more patient admissions and a greater availability of educational programming.

Alberta↗
PubMed1984

Retinoic acid-induced changes in epidermal growth factor binding and in biological responses mediated by phorbol ester tumor promoter.

We investigated the ability of retinoic acid (RA) to alter the binding of epidermal growth factor (EGF) to Rat-1 and Swiss mouse 3T3 cells, the EGF-related induction of ornithine decarboxylase (ODC) activity and DNA synthesis. Pretreatment of 3T3 cells with 10(-10)--10(-5) M RA produced a dose-dependent increase in EGF binding. The increased EGF binding appeared to result from an increased number of EGF receptors and did not occur in Rat-1 cells which, unlike 3T3 cells, possessed measureable amounts of cellular retinoic acid binding protein (CRABP). Both cell lines responded to RA pretreatment with an increase in EGF- and TPA-induced ODC activity, without a concomitant increase in DNA synthesis in either cell line. We suggest that the increase in EGF binding induced by RA in 3T3 cells is apparently unrelated to alterations in EGF-induced biological responses and to the presence of CRABP.

Animals↗
PubMed1983

A conjoint medical/nursing diabetes education program: impact on care in a rural community.

This paper describes the planning, teaching format, and evaluation of an interdisciplinary education program in diabetes mellitus for physicians and nurses in a rural Canadian community. Most participants preferred the conjoint teaching format to the unidisciplinary didactic programs traditionally offered. An evaluation, by chart review, of the management of diabetic patients cared for before and at 3, 6, and 12 months after the teaching program revealed significant changes in the referral practices of both the home care nurses and the physicians. Our findings suggest the occurrence of a program-related change in collaborative care practiced by the physicians and nurses who participated. A more extensive three year project has been initiated to further document the effectiveness of interdisciplinary continuing education in this community.

Alberta↗
PubMed1983

The effects of serum and phorbol ester tumor promoter on ornithine decarboxylase activity in Swiss 3T3 cells.

Addition of the tumor promotor 12-O-tetradecanoyl phorbol-13-acetate (TPA) to serum-deprived mouse 3T3 cells resulted in an increase in ornithine decarboxylase activity which is maximal at 3 h and declined thereafter. Addition of serum to these same cells resulted in an ornithine decarboxylase (ODC) response which was identical to the TPA-induced response at 3 h but continued to increase to a maximum at 6 h. A variant line of 3T3 cells, which possessed phorbol ester receptors, failed to increase its ODC in response to TPA. Also, the early component of the serum-induced ODC response was markedly diminished. These data suggest that phorbol ester tumor promoters may induce an early component of a more extensive ODC response, and that a component of serum may act through the same pathway as the phorbol esters.

Animals↗
PubMed1983

The effect of fluocinolone acetonide and 12-O-tetradecanoyl-phorbol-13-acetate on the binding and biological activity of epidermal growth factor in rat fibroblasts.

Synthetic glucocorticoids such as fluocinolone acetonide (FA) have been shown to be potent inhibitors of phorbol ester-mediated tumor promotion. When Rat-1 cells were incubated with FA the cells showed an increased capacity to bind [125I]-epidermal growth factor (EGF) to surface receptors. A partial reversal of the ability of the phorbol ester tumor promoter 12-O-tetradecanoyl-phorbol-13-acetate to reduce EGF binding to the class of high affinity receptors occurred following pre-exposure of cells to FA. The increased binding of EGF induced by FA resulted in a faster rate of degradation of EGF from the culture medium and reversed the inhibition of degradation caused by TPA. When EGF was present at low concentrations (less than or equal to 1 ng/ml), at which level FA was effective in increasing EGF degradation, FA-treated cells displayed a decreased induction of ornithine decarboxylase (ODC) activity and DNA synthesis. At higher EGF concentrations, the same level of ODC activity and DNA synthesis occurred in the presence or absence of FA, although some differences in the rates of induction were noted. These results support the hypothesis that the hyperplasia-inhibiting ability of glucocorticoid antipromoters may act by modulating EGF levels in the extracellular environment. However, our data also indicate that these antipromoters may act through other cellular mechanisms as well.

Animals↗
PubMed1981

Tumor promoter-induced inhibition of epidermal growth factor binding to cultured mouse primary epidermal cells.

The effect of the tumor promoter 12-O-tetradecanoylphorbol-13-acetate (TPA) and other diterpene derivatives on the binding of epidermal growth factor (EGF) to primary cultures of mouse epidermal cells was studied. 125I-EGF was used to study the specific binding of the growth factor to monolayer cultures of mouse epidermal cells grown under low-calcium culture conditions (0.06 mM Ca2+). Under these growth conditions, nonspecific binding did not exceed 10%. Initially, TPA decreased the binding of 125I-EGF to cells. However, when cells were incubated continuously in TPA plus EGF (0.25 ng/ml) for 19 hr, there was more EGF bound to the TPA-treated cells than to control cells. This phenomenon was not observed at high (5 ng/mg) EGF concentrations. Scatchard analysis of specific 125I-EGF binding at 4 degrees after a 1-hr pretreatment of the cells with TPA at 37 degrees converted a curvilinear plot to a linear plot. TPA induced a 25% decrease in the number of receptors per cell and eliminated binding of EGF to a class of high-affinity receptors. Preincubation of cells in TPA at 37 degrees for up to 13 hr followed by Scatchard analysis at 4 degrees showed that the curvilinear plot was restored and that the effects of TPA were partially reversible. TPA did not alter the rate at which bound EGF was degraded. However, at low EGF concentrations, TPA reduced the amount of EGF that was metabolized. The greater amount of EGF bound to TPA-treated cells over controls after long-term incubation was due to the presence of larger amounts of whole EGF in the media of TPA-treated cells at a time when the cells have regained their ability to bind EGF. A series of diterpene derivatives of different abilities to act as tumor promoters and hyperplasia-inducing agents were tested for their ability to influence EGF binding. The abilities of members of this series to decrease EGF binding and prevent degradation of EGF correlated more with their potentials to induce hyperplasia than with their tumor-promoting potentials. The ability of these diterpene derivatives to induced DNA synthesis with EGF synergistically may depend on the transient sparing of the EGF from degradation and subsequent binding of the spared EGF.

Animals↗