PubMed Health⌕ Search

Biomedical subjects

P Ayres

Publications and source records attributed to P Ayres.

15 recordsLinked to original sources
PubMed2000

Quantification of major classes of Xenopus phospholipids by high performance liquid chromatography with evaporative light scattering detection.

Lipid signaling has become a major research area of cell biology and there is a need for methods that accurately and easily measure substrates and products of lipases involved in cell signaling. In this report, we provide new methodology for separation of more than 10 lipids in one chromatographic run by high pressure liquid chromatography (HPLC) and detection with an evaporative light scattering detector (ELSD). There is no significant loss of sphingomyelin and no large baseline change, no peak obscures another, and acidic phospholipids are cleanly separated. We have optimized the procedure for a two-pump HPLC, an inexpensive silica column without the use of a column heater jacket and for low grade nitrogen. An application of the procedure separates lipids from Xenopus laevis cells. These cells are commonly used in the study of various lipid signaling paths in cell division, fertilization, and after expression of exogenous membrane receptors.

Animals↗
PubMed1999

Cardiovascular responses to a hot tub bath.

This study was conducted to determine the cardiovascular effects of 15 minutes of hot tub immersion at 39 degrees C. Five college-age subjects (4 males and 1 female) volunteered to participate in this study. Assessments were made while sitting first in a chair for 5 minutes and then in the hot tub for 15 minutes. Oxygen consumption (VO2) and cardiac output (Q) measurements were made using a Medical Graphics CPX/D metabolic analyzer. Cardiac output was determined at minute 15 using the indirect CO2 rebreathing procedure. The data were analyzed using the analysis of variance with repeated measures, which indicated that at minute 15, heart rate (HR) and Q were increased, which increased VO2. The increase in Q was due to the heart rate (HR) response and the decrease in systemic vascular resistance (SVR). Mean arterial pressure (MAP) and systolic blood pressure (SBP) were decreased while double product (DP) was increased. There were no changes in stroke volume (SV) or arteriovenous oxygen difference (a-vO2 diff). These findings indicate that the HR and Q responses are necessary to the increase in metabolism (VO2). Hot tube use within these time and temperature constraints should reduce concern over hot tub safety in college-age subjects.

Adult↗
PubMed1999

Management of major trauma: changes required for improvement.

AIMS: To describe the views of key healthcare professionals on the changes they considered to be important in the reduction of major trauma mortality between 1988 and 1995 in Leeds. METHODS: Qualitative unstructured interviews with a purposive sample of 10 healthcare professionals deemed to be key personnel by an experienced consultant who had provided acute trauma care throughout the relevant period. Each interview was tape recorded and transcribed; each transcript was analysed for important themes by two independent researchers who then discussed their results to resolve any differences in interpretation. RESULTS: Three categories of change became evident: "policy", "infrastructure", and "philosophy of care". Each of these categories seemed to be equally important. Policy changes identified as important were the Royal College of Surgeons of England's report into trauma care (1988), the setting of standards for paramedic training, and the national audit of major trauma outcomes. Important infrastructure changes identified were training in advanced trauma life support, decreased ambulance response times, reorganisation towards "consultant led" hospital services, and an emphasis on quality monitoring. Changes in philosophy of care were increases in levels of teamwork, commitment, communication, and confidence. Together these facilitated an overall restructuring and refocusing of care. CONCLUSIONS: No individual change is seen as dominant for improved care, but rather a strategic mixture of facilitating national and regional policy guidance, organisational restructuring, and congruent professional attitudes were integral components leading to the observed changes. Improving outcomes in other areas is likely to involve an integrated series of changes which must be managed as a total system.

Attitude of Health Personnel↗
PubMed1999

Clinical governance: setting the scene.

The concept of clinical governance was first introduced to the NHS in late 1997. Since then, it has become a commonly used term, but there is still a great deal of uncertainty about what it means and how it should be implemented. This paper places clinical governance in the context of previous quality initiatives, and considers the roles of both managers and clinicians.

Evidence-Based Medicine↗
PubMed1997

Public health in hospitals: new steps in old directions.

A pilot scheme of hospital epidemiologists in the Northern and Yorkshire region has provided an exciting opportunity to promote a public health perspective among hospital clinicians. Responsibilities and roles of the posts include the promotion of clinical effectiveness and evidence-based practice, epidemiological support for audit, research and clinical evaluation, liaison with primary care and public health colleagues in health authorities, and the development and implementation of clinical guidelines. Although the posts are not restricted to public health specialists, public health training and skills provide an excellent foundation from which to meet the challenges that arise from the posts. We discuss some of the lessons learnt by two public health doctors from the early steps in this new direction.

Career Mobility↗
PubMed1997

What are hospitals doing about clinical guidelines?

OBJECTIVES: To assess the attitudes of senior hospital staff towards clinical guidelines, and to ascertain the perceived extent and benefits of their local use; to identify those hospitals with current or planned future written strategies for the systematic development of clinical guidelines, and the staff responsible for leading them; and to establish the essential elements of existing strategies, and the methods used to ensure the proper development, dissemination, implementation, and evaluation of local guidelines. DESIGN: Cross sectional survey. PARTICIPANTS: Senior staff of 270 acute hospitals in the United Kingdom (response rate 202/270 (75%)) in 1995. RESULTS: 197/199 (99%) of respondents thought that clinical guidelines were a good idea, and 176/196 (90%) were aware of some guideline activity occurring within their hospitals. The most important benefits of local guideline activity were increased healthcare efficiency and effectiveness, greater consistency of treatment, and team building. 174/194 (90%) of respondents were in favour of the development of a readily accessible national repository of evidence-based clinical guidelines. 38/201 (19%) of respondents had a clinical guidelines strategy and a further 91/201 (45%) said that they had plans to develop one in the near future. The need to improve clinical outcomes was most often reported as the reason for developing a strategy. Medical directors most commonly had formal responsibility to lead the strategy, but someone without formal responsibility ran the operation in half the hospitals. Only 18/36 (50%) of strategies gave advice on the development of guidelines; and only a few strategies made explicit statements on which clinical services to target for guideline development, or the methods to be used for their validation and promotion. Some strategies lacked explicit statements on methods to monitor adherence, routine review, and update of guidelines. Internal literature searches (29/31 (94%)), the use of national guidelines (29/32 (91%)), local consensus conferences (28/32 (88%)), and peer group review (21/24 (88%)) were the most popular methods of validation used in hospitals with a strategy. Methods used to promote the dissemination, implementation, and evaluation of clinical guidelines included clinical audit (31/32 (97%)), peer review (25/30 (83%)), continuing education (23/29 (79%)), targeting of opinion leaders (17/26 (65%)), use of structured case notes (14/31 (45%)), patient mediated interventions (9/26 (35%)), and patient specific reminders (8/26 (31%)). CONCLUSIONS: Most senior hospital staff have a favourable attitude towards clinical guidelines. Most hospitals are undertaking some guideline activity, but few seem to be doing so within a locally agreed hospital wide strategy in which guideline development, dissemination, implementation, and evaluation are systematically considered. Many of the current methods used to validate guidelines locally are inadequate. Evidence-based clinical guidelines should be developed nationally, leaving hospitals to focus their energies on the local adaptation, dissemination, implementation, and evaluation of such guidelines. Only in this way will local guidelines achieve their full potential to improve clinical care and patient outcomes.

Attitude of Health Personnel↗
PubMed1996

Part I of Membership of the Faculty of Public Health Medicine (MFPHM). Trends over time and factors associated with success in recent years.

BACKGROUND: The examination for Membership of the Faculty of Public Health Medicine (MFPHM) Part I, has been held for nearly 20 years. It aims 'to test the candidate's knowledge and understanding of the basic sciences of public health'. This paper presents simple statistics from the earliest years up to June 1995 and additional information on more recent sittings. METHOD: The number of people taking the examination and the proportion passing were obtained for every sitting from February 1978 to June 1995. Further data have been extracted for all sittings of the examination since the current regulations were introduced. The variables included were pass or fail as the outcome variable, date of birth, gender of candidate, postgraduate qualifications, present post of employer, and attendance at a formal academic course. RESULTS: The number of candidates has ranged from 12 to 115, the proportion passing from 42 per cent to 93 per cent. During the period from June 1992 to June 1995, 472 people applied to sit the examination. Of these 33 withdrew, leaving 439 person attempts. The overall proportion passing was 270/439 (61.5 per cent). Factors associated with success include being female, being a UK graduate, attending an academic course and having more experience in the specialty. CONCLUSION: Candidates and their tutors are reminded of the need for adequate preparation for the examination. The authors welcome comments on how monitoring should be carried out in the future.

Adult↗