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Biomedical subjects

M Cooke

Publications and source records attributed to M Cooke.

At least 37 records · Page 2Linked to original sources
PubMed2000

The effects of vitamin C supplementation on protein oxidation in healthy volunteers.

We have investigated vitamin C supplementation effects on immunoglobulin oxidation (carbonyls) and total plasma protein sulfhydryls in healthy human volunteers. After receiving placebo, plasma ascorbate and oxidation markers were unchanged. Following 5 weeks supplementation with vitamin C (400 mg/day), plasma ascorbate increased but no significant effect on protein oxidation was observed. At 10 and 15 weeks supplementation, carbonyl levels were significantly reduced (P < 0.01) in subjects with low baseline ascorbate (29.51 +/- 5.3 microM) but not in those with normal baseline ascorbate (51.81 +/- 2.3 microM). To eliminate any effect from seasonal variation in dietary antioxidant intake, a second phase was undertaken. Subjects on vitamin C for 15 weeks were randomly assigned to receive either placebo or vitamin C. No difference in plasma sulfhydryl content was observed. Subjects withdrawn from supplementation showed an increase in immunoglobulin carbonyl content (P < 0.01). This demonstrates that dietary vitamin C supplementation can reduce certain types of oxidative protein damage in subjects with low basal antioxidant.

Adult↗
PubMed2000

A library of atmospheric pressure ionization daughter ion mass spectra based on wideband excitation in an ion trap mass spectrometer.

A searchable library of MS/MS spectra obtained using a quadrupole ion trap mass spectrometer and electrospray or atmospheric pressure chemical ionization is presented. The application of wideband excitation (activation) and normalized collision energy leads to highly reproducible mass spectra which are searched using the NIST algorithm. Flow injection and LC/MS/MS applications of this powerful technique in the biomedical (diastereoisomeric steroids, morphine glucuronides, isovalerylcarnitine) and environmental (pirimicarb and desmethyl-pirimicarb) areas are described.

Algorithms↗
PubMed2000

The heavy metal content of the teeth of the bank vole (Clethrionomys glareolus) as an exposure marker of environmental pollution in Poland.

This investigation is based on the premise that heavy metals are sequestered by the mineral phase of teeth, hydroxyapatite, during their formation. Once formed these tissues are not subject to significant turnover and it is suggested, therefore, that they provide a permanent and cumulative record of heavy metal exposure during the development of the teeth. The teeth of the bank vole (Clethrionomys glareolus) were analysed by inductively coupled plasma mass spectrometry to monitor the animals' exposure to lead, cadmium, zinc, copper and strontium. Animals were trapped in clean and polluted areas in Poland in and around Krakow in 1996 and in Olkusz and Legnica in 1996 and 1997. The control area in 1996 was Bieszcady National Park and in 1997 Borecka Forest. The results showed that there were statistically different concentrations of heavy metals in the teeth of animals from different sites. The high levels of pollution from industrial emissions were related to higher concentrations of heavy metals in the teeth. Unexpectedly high levels of heavy metals in the teeth of animals from Bieszczady National Park, thought to be environmentally clean, suggested cross-border pollution from Slovakia and the Ukraine. It was concluded that the teeth of small mammals, such as the bank vole, are a sensitive and reliable marker of environmental pollution by heavy metals.

Journal Article↗
PubMed2000

Goals and strategies for teaching death and dying in medical schools.

Teaching medical students to respond to needs of the dying represents an important challenge for medical educators. This article describes the goals and objectives that should be identified before medical schools can meet this challenge, as well as strategies that, when implemented, will provide students with the necessary knowledge, skills, and attitudes to meet the needs of the dying patients. The goals and objectives were identified through a modified group consensus process developed during Choice In Dying's 5-year project "Integrating Education on Care of the Dying into Medical Schools." The authors have diverse experiences and backgrounds and are actively involved in death and dying teaching at 11 medical schools. They conclude that after accepting the goals and objectives, key medical school faculty can work cooperatively to develop strategies to integrate them into the school's curriculum. Without first establishing a set of goals and objectives and developing evaluation methods, medical schools could miss their mark in fostering the student's ability to care for the dying.

Journal Article↗
PubMed1999

A strategy for the detection and evaluation of unprofessional behavior in medical students. University of California, San Francisco School of Medicine Clinical Clerkships Operation Committee.

The authors describe the first four years (1995-1998) in which the University of California, San Francisco School of Medicine operated an evaluation system to monitor students' professional behaviors longitudinally through their clinical rotations. The goals of this system are to help "turn around" students found to have behaved unprofessionally, to demonstrate the priority placed by the school on the attainment of professional behavior, and to give the school "muscle" to deal with issues of professionalism. A student whose professional skills are rated less than solid at the end of the clerkship receives a "physicianship report" of unprofessional behavior. If the student receives such a report from two or more clerkships, he or she is placed on academic probation that can lead to dismissal even if passing grades are attained in all rotations. Counseling services and mentoring by faculty are provided to such students to improve their professional behaviors. From 1995 to 1998, 29 reports of unprofessional behavior on the part of 24 students were submitted to the dean's office; five students received two reports. The clerkship that submitted the most reports was obstetrics-gynecology. The most common complaint for the five students who received two reports was a poor relationship with the health care team. Four of these students had their difficulties cited in their dean's letters and went on to residency; the fifth voluntarily withdrew from medical school. The authors describe the students' and faculty members' responses to the system, discus lessons learned, difficulties, and continuing issues, review future plans (e.g., the system will be expanded to the first two years of medical school), and reflect on dealing with issues of professionalism in medical school and the importance of a longitudinal (i.e., not course-by-course) approach to monitoring students' behaviors. The authors plan to compare the long-range performances of students identified by the evaluation system with those of their classmates.

Adult↗
PubMed1999

Best practice organizational effectiveness in NHS Trusts. Leeds Teaching Hospitals NHS Trust. Case study.

Measuring organisational effectiveness in a health-care delivery context is quite a challenging task. Although there are numerous performance assessment models, audit tools and managerial diagnostic tools, they all, however, tend to fall short in their attempts to scrutinize how health-care organizations deploy their capabilities to deliver optimum quality in service provision and what performance levels they achieved as a result of their approach. The project reported here attempted to address these issues, reflecting the experience of Leeds Teaching Hospitals, one of a series of Trusts whose approach to organizational effectiveness was closely examined.

Benchmarking↗
PubMed1999

Best practice organisational effectiveness in NHS Trusts. Allington NHS Trust case study.

Measuring organisational effectiveness in a health care delivery context is a challenging task. Although there are numerous performance assessment models, audit tools and managerial diagnostic tools, they all tend to fall short in their attempts to closely scrutinize how health care organisations deploy their capabilities to deliver optimum quality in service provision and what performance levels they achieve as a result of their approach. The project reported here attempted to address the aforementioned issues. It set out to examine health care providers from an integrated perspective and to assess the key drivers of effective organisational performance using an adapted model based on the 7s' principles. The research project culminated into a major report highlighting best practices found to be inherent in 18 well performing health care providers. This paper reflects the experience of one of a series of Trusts whose approach to organisational effectiveness was closely examined.

Community Health Services↗
PubMed1999

The dissemination of a smoking cessation program to 23 antenatal clinics: the predictors of initial program adoption by managers.

OBJECTIVE: To investigate whether the method of dissemination, antenatal clinic practice norms for smoking intervention and subjective evaluation of the attributes of a new smoking cessation program are associated with a nurse unit manager's initial decision to adopt the new program. METHOD: Twenty-three hospital clinics were randomly allocated to two groups which received the program either by simple or intensive dissemination methods. Simple dissemination involved a mailout of the 'Fresh Start' program and intensive dissemination involved a mailout which was enhanced by personal contact with midwifery facilitators who provided support and training for the program. It was hypothesised that intensive dissemination would improve program adoption compared to simple dissemination. It was also hypothesised that managers' perceptions of the program and clinic smoking intervention practice norms would predict program adoption. A hierarchical regression analysis was used to examine the association between these variables and the adoption of program components. RESULTS: The results indicated that the method of dissemination and the managers' perceptions of the program are significant predictors of program adoption. CONCLUSIONS: Although clinic practice norm for smoking cessation education is not a significant predictor of program adoption, it appears to mediate managers' perceptions of the program.

Female↗
PubMed1999

Are we providing adequate postnatal services?

Over the past 10 years, there have been significant changes to postnatal services. There is insufficient research that evaluates the effect these changes have on the physical and psychological outcomes of women and families or the level of support women and children actually require in the first postnatal year. We argue that there is an urgent need for research which tests the outcomes and cost effectiveness of different models of postnatal care currently being offered. The most rigorous research methods possible are necessary to provide robust evidence to prevent the degradation of postnatal maternity services. This research should evaluate the relative advantages and disadvantages of different models of postnatal care as well as describe the content and quality of postnatal services. Knowledge gained from such research would and should assist the development of recommendations and policies for postnatal midwifery and early childhood practice in Australia.

Female↗
PubMed1999

Group challenge.

Explore the source record for details and available documents.

Decision Making, Organizational↗
PubMed1999

Do patients' ethnic and social factors influence the use of do-not-resuscitate orders?

OBJECTIVES: To determine whether ethnic and other social factors affect how frequently do-not-resuscitate (DNR) orders are written, the timing of DNR orders, or patient involvement in the DNR decision. DESIGN: Retrospective cohort. METHODS: Patients who died in one urban teaching hospital on the medicine, cardiology, or family practice service during 1988 were eligible; 288 were included in the analyses. Chi-square tests and logistic regression were used to examine frequency of DNR orders and patient involvement; analysis of variance and linear regression were used to examine timing of the DNR orders. RESULTS: Non-whites were more likely than whites to have DNR orders (OR 1.76; 95% CI, 1.09-2.84) but timing of the DNR order did not vary significantly by race/ethnicity. Patients who spoke English fluently were more likely to be involved in the DNR decision than those who did not (OR 1.28; 95% CI, 1.01-1.61). Patients with documented human immunodeficiency virus were more likely than uninfected patients to have DNR orders (OR 3.51; 95% CI, 1.36-9.02), to be involved in the decision (OR 10.11; 95% CI, 4.87-21.00); and to have DNR orders written earlier (P = 0.02). Alcoholic patients were more likely than non-alcoholics to have DNR orders (OR 1.17; 95% CI, 1.04-1.33). CONCLUSIONS: Ethnic and other social factors do appear to play a role in DNR decisions. It needs to be determined if these differences are due to patient preferences or clinician characteristics.

Adult↗
PubMed1999

Physicians' transmission prevention assessment and counseling practices with their HIV positive patients.

Physicians can help prevent transmission of HIV by assessing HIV positive patients for risky sexual and needle-sharing behaviors, and by providing risk reduction counseling. From 1995 to 1997, we gathered data on the HIV transmission prevention assessment and counseling practices of 44 San Francisco Bay area physicians in face-to-face, semistructured interviews. A refined coding scheme and constant comparative analytic method were used. Although physicians varied in their responses to coded items, two styles of engagement, at the extremes, emerged from the data: "consultant" and "collaborator." Consultants conducted transmission prevention assessment and counseling during initial visits or upon medical cues (e.g., presence of sexually transmitted diseases) and viewed themselves primarily as information sources, whereas collaborators regularly conducted transmission prevention counseling and viewed themselves as actively helping patients reduce transmission risk. Physicians who fell between the two styles generally did not conduct regular counseling themselves, but many used referrals to health educators. The findings suggest that consultant and collaborator styles may influence patients differently, and offer insight into the role that physicians can play in transmission prevention with HIV positive patients.

Adult↗
PubMed1998

Informal caregivers and the intention to hasten AIDS-related death.

OBJECTIVES: To determine the extent to which homosexual men dying of the acquired immunodeficiency syndrome (AIDS) receive medication intended to hasten death. To assess the impact on caregivers of administering medications intended to hasten death. METHODS: In a prospective study of caregiving partners of men with AIDS (n = 140), characteristics of the ill partner, the caregiver, and the relationship were assessed at baseline and 1 month before the ill partner's death. Three months after the death, caregivers were asked if they had increased their partner's narcotic and/or sedative-hypnotic medication dose and if so, what had been the objective of the increase, and their comfort with their medication decisions. RESULTS: Of 140 ill partners who died of AIDS, 17 (12.1%) received an increase in the use of medications immediately before death intended to hasten death. Diagnoses and care needs of ill partners who received increases in the use of medications to hasten death did not differ from those of ill partners receiving medication for symptoms. Fourteen increases (10%) in use of medications were administered by caregivers. These caregivers did not differ from those administering medication for symptom control in level of distress, caregiving burden, relationship characteristics, or comfort with the medication decision, but they reported more social support and positive meaning in caregiving. CONCLUSION: The decision to hasten death is not a rare event in this group of men. There is no evidence that it is the result of caregiver distress, poor relationship quality, or intolerable caregiving burden; and it does not cause excessive discomfort in the surviving partner. This study, although small, has implications for the policy debate on assisted suicide.

Acquired Immunodeficiency Syndrome↗
PubMed1998

The nature of the problem: the intentional design of problems to facilitate different levels of student learning.

This paper explores the deliberate design of 'problem' situations within a 3-year problem-based nursing degree conducted at Griffith University, Nathan, Queensland, Australia. It examines problem situations within the first and third years of the course to illustrate the issues involved in designing material that enables students to achieve the curriculum aims. Although the problem situations are designed from the same health care setting, the discussion highlights how concepts and issues can be addressed in different ways depending on the desired student outcomes. The paper outlines and examines the nature of student learning and the clinical reasoning process used by students in making decisions that closely mirror those made as registered nurses in order to facilitate the achievement of clients' health goals.

Curriculum↗
PubMed1998

The influence of individual and organizational factors on the reported smoking intervention practices of staff in 20 antenatal clinics.

This study investigates the factors which influence the reported use of a smoking cessation interventions in antenatal clinics. Midwives and doctors in 20 hospital antenatal clinics (n = 203) completed a survey designed to measure their perceptions, knowledge and use of brief interventions for smoking. Measures for hospital structure and work climate were also obtained. The aims of the study are: to describe the smoking intervention practice of antenatal clinic staff and to ascertain the organizational and practitioner variables which predict clinician use of smoking interventions. The results indicate that the majority of antenatal clinic staff do not use the most effective forms of brief interventions for smoking. The presence of specific procedures and training in smoking cessation intervention appear to be the most important predictors of reported smoking intervention in hospital antenatal clinics.

Journal Article↗
PubMed1998

Primary care groups will have to be good at this, and that and the other.

Functions of primary care groups (PCG) should be considered ahead of structures and those forming PCGs need to see the links between the key health and social policy initiatives. Early influence by PCGs will shape the design and local implementation of health action zones, health improvement programmes and performance frameworks. The Green Paper "Our Healthier Nation" and its successor are central to the emerging role of PCGs. Partnership work between GPs, practice staff, trusts, local authorities and health authorities needs emphasis. Recognition of what people and existing organisations can contribute needs to be given. Leadership themes of good primary care operations, health development and clinical leadership or their equivalents need time and space to emerge.

Family Practice↗