Biomedical subjects

John Cape

Publications and source records attributed to John Cape.

5 recordsLinked to original sources

PubMed2006

Patients' experiences of GP consultations for psychological problems: a qualitative study.

BACKGROUND: The vast majority of patients with psychological problems are seen solely by their GP, but little is known about patients' perspectives regarding the variety of consultation skills that may be used in routine GP consultations with these patients. AIM: To identify which aspects of GP consultations patients presenting with psychological problems experience as helpful or unhelpful. DESIGN: Qualitative study. SETTING: Nine general practices in north central London. METHOD: Twenty patients, who had discussed psychological problems as a significant part of their index GP consultation, were asked in detail using the tape-assisted recall (TAR) method, about aspects of the consultation they had experienced as helpful or unhelpful. RESULTS: All patients described how the relationship with the GP helped or hindered them in discussing their problems; this was central to their experience of the consultation. An underlying attitude of genuine interest and empathy, within a continuing relationship, was highly valued. Patients also described how the GP helped them make sense of, or resolve their problems, and supported their efforts to change. CONCLUSION: These patient accounts suggest that routine GP consultations for psychological problems can have a powerful impact, at least short-term. The GP role in providing a safe place where patients feel they are listened to and understood should not be underestimated, particularly in the mental health context. Further research is required to investigate the longer-term impact of different GP behaviours on patient health outcomes. The TAR method has potential applications in primary care research and in the training of GPs and other health professionals.

Adult↗

PubMed2004

Characterization of the high-spin heme x in the cytochrome b6f complex of oxygenic photosynthesis.

X-ray structures at 3.0-3.1 A resolution of the cytochrome b(6) f complex from the cyanobacterium Mastigocladus laminosus [Kurisu, G., Zhang, H., Smith, J. L., and Cramer, W. A. (2003) Science 302, 1009-1014] and the green alga Chlamydomonas reinhardtii [Stroebel, D., Choquet, Y., Popot, J.-L., and Picot, D. (2003) Nature 426, 413-418] showed the presence of a unique heme, hemex, that is covalently linked by a single thioether bond to a Cys residue (Cys35) on the electrochemically negative (n) side of the cytochrome b(6) polypeptide. Heme x faces the intermonomer quinone exchange cavity. The only axial ligand associated with this heme is a H(2)O or OH(-) that is H-bonded to the propionate of the stromal side heme b(n), showing that it is pentacoordinate. The spectral properties of this heme were hardly defined at the time of the structure determination. The pyridine hemochromagen redox difference spectrum for heme x covalently bound to the cytochrome b polypeptide isolated from SDS-PAGE displays a low-amplitude broad spectrum with a peak at 553 nm, similar to that of other hemes with a single thioether linkage. The binding of CO and a hydrophobic cyanide analogue, butyl isocyanide, to dithionite-reduced b(6) f complex perturbs and significantly shifts the redox difference visible spectrum. Together with EPR spectra displaying g values of the oxidized complex of 6.7 and 7.4, heme x is defined as a ferric high-spin heme in a rhombic environment. In addition to a possible function in photosystem I-linked cyclic electron transport, the five-coordinate state implies that there is at least one more function of heme x that is related to axial binding of a physiological ligand.

Binding Sites↗

PubMed2002

Practice improvement methods: conceptual base, evidence-based research, and practice-based recommendations.

OBJECTIVES: To provide (1) an overview of the purpose of practice improvement methods and a conceptual base for the relationship between the various practice improvement methods; (2) an evidence-based review of the range of practice improvement methods; and (3) practice-based recommendations. DESIGN AND METHOD: Secondary research design using electronic literature search of PsycINFO database was carried out on eight practice improvement methods (PIMs) and the evidence for effectiveness presented. RESULTS: There is evidence of effectiveness in changing practice for each of the PIMs reviewed, and for some, there is also evidence of effects on patient outcomes. Each has strengths and weaknesses. However, the stronger conclusion from reviews is that use of multiple PIMs is more likely to impact clinical practice and patient outcomes than use of a single PIM. CONCLUSION: The development of PIMs should concentrate on combination and integration between methods to maximize their effectiveness.

Databases as Topic↗

PubMed2002

Consultation length, patient-estimated consultation length, and satisfaction with the consultation.

Lack of time is a frequently expressed patient concern, but actual measured consultation length is often not associated with patient satisfaction. Correlational analysis of patients from nine GP practices was used to test the hypothesis that patients' perceptions of consultation length are influenced not just by actual consultation length, but by other aspects of their experience of consultations. The consultations of 160 patients were timed, and patients in subsequent interviews gave estimates of consultation duration and completed a satisfaction questionnaire. Consultations where patients were more satisfied appeared to patients to have lasted longer (partial correlation r = 0.26), but were not actually longer. Patient concerns about time may be as much about quality time as about actual time.

Adolescent↗

PubMed2001

Rated casemix of general practitioner referrals to practice counsellors and clinical psychologists: A retrospective survey of a year's caseload.

Although evidence-based guidelines are beginning to be produced as to which psychological therapies might be appropriate for which patients, little is known about how general medical practitioners (GPs) in practice distribute referrals between different psychological therapy services. In a retrospective survey, 19 practice counsellors and 10 clinical psychologists from the same geographical area rated a year's caseload of GP referrals using identical data collection methods. Rated casemix was found to be broadly similar, although practice counsellors rated relationship and bereavement problems as more common in their caseloads (totalling 986 patients), and clinical psychologists rated panic disorder, phobias, and obsessive-compulsive problems as more common in their caseloads (totalling 320 patients). Depression and anxiety reactions were the most common problems rated in both groups, but the clinical psychologist cases of depression were rated as more severe and complex. Where differences were found, they may have reflected the different ways that counsellors and clinical psychologists conceptualize cases rather than actual differences in casemix. The results are discussed in relation to evidence-based guideline recommendations about cases appropriate to be seen by practice counsellors and by clinical psychologists in primary and secondary care, and the need to adapt such guidance to local services and skills of practitioners.

Journal Article↗