Biomedical subjects

L McKechnie

Publications and source records attributed to L McKechnie.

5 recordsLinked to original sources

PubMed2006

Dietetic guidelines on food and nutrition in the secondary prevention of cardiovascular disease - evidence from systematic reviews of randomized controlled trials (second update, January 2006).

AIM: To update dietetic guidelines based on systematic review evidence on dietary advice to prevent further events in people with existing cardiovascular disease (CVD) (secondary prevention). METHODS: The Cochrane Library, MEDLINE and EMBASE were comprehensively searched to January 2005 for systematic reviews on aspects of diet and heart health. Reviews were included if they searched systematically for randomized controlled trials relating to diet and secondary prevention of CVD. Each review was critically appraised by at least two members of the UK Heart Health and Thoracic Dietitians Group. The quality and results of each review were discussed and summarized at a group meeting. RESULTS: Evidence-based strategies that reduce cardiovascular events in those with CVD include reduction in saturated fat and substitution with unsaturated fats. Individuals who have suffered a myocardial infarction may also benefit from adopting a Mediterranean type diet and increasing intake of omega 3 fats, but it is not clear whether they are beneficial for all patients with CVD. There is no systematic review evidence to support the use of antioxidant vitamins supplements, low glycaemic index diets, or homocysteine lowering therapies in this group. CONCLUSION: There remains good evidence that reducing saturated fat reduces morbidity in patients with CVD. This advice is consistent for most manifestations of CVD, with the addition of Mediterranean dietary advice and increased omega 3 fats for those who have had a myocardial infarction.

Antioxidants↗

PubMed2006

Consent for neonatal research.

Inherent to all medical research is respect for the rights of the individual. Neonatal research is made more complex by the issue of proxy consent. Obtaining valid informed consent for entry of an infant into a research project needs to deal with this complexity. New evidence on the role and responsibilities of parents in giving consent has implications for all clinical staff that are considering embarking on and/or recruiting infants in research projects. This review explores the issues around informed consent for neonatal research and provides a framework by which consent could be improved. It is to be hoped that such improvements to the process will increase recruitment of infants to research studies while enhancing the validity of the consent process.

Attitude to Health↗

PubMed2004

Joint working in community mental health teams: implementation of an integrated care pathway.

Abstract Integration of community mental health services is a key policy objective that aims to increase quality and efficiency of care. Integrated care pathways (ICPs) are a mechanism designed to formalise multi-agency working at an operational level and are currently being applied to mental health services. Evidence regarding the impact of this tool to support joint working is mixed, and there is limited evidence regarding the suitability of ICPs for complex, community-based services. The present study was set in one primary care trust (PCT) in Scotland that is currently implementing an ICP for community mental health teams (CMHTs) across the region. The aim of the study was to investigate professionals' experiences and views on the implementation of an ICP within adult CMHTs in order to generate learning points for other organisations which are considering developing and implementing such systems. The study used qualitative methods which comprised of individual interviews with three CMHT leaders and two service development managers, as well as group interviews with members of four adult CMHTs. Data was analysed using the constant comparison method. Participants reported positive views regarding joint working and the role of an ICP in theory. However, in practice, teams were not implementing the ICP. Lack of integration at higher organisational levels was found to create conflicts within the teams which became explicit in response to the ICP. Implementation was also hindered by lack of resources for ongoing support, team development and change management. In conclusion, the study suggests that operational systems such as ICPs do not address and cannot overcome wider organisational barriers to integration of mental health services. Integrated care pathways need to be developed with strategic input as well as practitioner involvement and ownership. Team development, education about integration and change management are essential if ICPs are to foster and support joint working in integrated teams.

Community Mental Health Services↗

PubMed1999

Uptake and timing of immunisations in preterm and term infants.

Preterm infants are more at risk of complications from infectious disease and should be immunised as a matter of priority. This retrospective study followed the immunisations given to 110 premature infants and 220 control term infants admitted to the Neonatal Unit at the Royal United Hospital, Bath over a 12-month period. The overall immunisation uptake for infants admitted to the neonatal unit was 99.93, better than for the general population of the area. However, in both preterm and term infants there were considerable variations in the age at which each immunisation was given. Fewer of the preterm infants had their first three immunisations on time. The difference in timings between the two groups was statistically significant. Earlier immunisations were more often given on time than later ones. The greater the gestational age, the more likely that the infant would be immunised at the correct times. It is important to stress to parents the importance of immunisation for babies who are born prematurely or who have been unwell.

Age Factors↗

PubMed1984

The relationship between liver function tests and alcohol intake in patients admitted to an alcoholism unit.

Values of various blood plasma tests have been determined in heavy drinkers admitted to an Alcoholism Unit and in a reference group of occasional social drinkers. These tests were total protein, albumin, bilirubin, alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), aspartate amino transferase (AST) and amylase. The aim of this study was to assess the reliability and validity of GGT and AST as indices of alcohol intake in heavy drinkers entering an Alcoholism Unit. The data indicate that in the patients group intra-personal variance and analytical variances are relatively small compared with the between-person variance. The data also indicate, however, that in the patients group GGT and AST are not valid group indices of alcohol intake since the between-person variation is large and the correlation with alcohol intake is weak due to large differences in the dose-response relationship between individuals. AST and GGT are poor indicators of alcohol intake in admissions to an Alcoholism Unit.

Adult↗