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Biomedical subjects

P G Alley

Publications and source records attributed to P G Alley.

16 recordsLinked to original sources
PubMed1997

Health service reform: the perceptions of medical specialists in Australia (New South Wales), the United Kingdom and New Zealand.

OBJECTIVE: To examine the effect of recent healthcare service changes (including significant resource constraint and a greater role for the non-medical manager) in the United Kingdom, Australia and New Zealand on medical specialists' perceptions of their healthcare organisation goals and service delivery, and their enthusiasm for their work. DESIGN: Postal questionnaire survey, answered anonymously. PARTICIPANTS AND SETTING: Medical specialists employed either part- or full-time in two United Kingdom National Health Service Trusts (one acute, one mental health/community service), an Australian Area Health Service and a New Zealand Crown Health Enterprise in 1995. MAIN OUTCOME MEASURES: Participants' rating of their knowledge of employers' organisational goals, ability to influence management, perceptions of changes in resources and service availability since 1990 and changes in enthusiasm for their work over the past four years. RESULTS: 369 of 521 eligible specialists responded (71%); by country-United Kingdom, 123/186 (66%); New Zealand, 123/160 (77%); Australia, 123/175 (70%). New Zealand specialists were less aware of their employers' organisational goals and had less congruence between these and their own personal goals than United Kingdom or Australian specialists (P < 0.05). Interest in influencing central management was similar in the three countries, but Australian specialists felt management was less likely to follow their advice compared with United Kingdom specialists (P < 0.05). New Zealand specialists perceived that waiting times for non-urgent patients were currently longer than in 1990 compared to United Kingdom specialists (P = 0.02). In all three countries, inpatient beds were perceived to be less available than in 1990, but less so in New Zealand. The ease of replacing equipment was better in New Zealand than in Australia and the United Kingdom (P = 0.00001). More than 50% of participants in all three countries (183/361; 50.7%) reported that their enthusiasm for their work had decreased in the past four years. CONCLUSION: The effects of health service reforms seem to have reduced enthusiasm for work among medical specialists in Australia, the United Kingdom and New Zealand.

Attitude of Health Personnel↗
PubMed1995

Sources of stress and satisfaction in crown health enterprise senior medical staff.

AIM: To report the sources of stress and satisfaction in the specialist workforce of three crown health enterprises (CHEs). METHOD: Ninety eight specialists in Northland Health, Waitemata Health and Southern Health completed a questionnaire rating 39 factors for causing stress and satisfaction in their daily work. RESULTS: The commonest sources of stress for specialists were keeping up to date, carrying a heavy clinical workload and time pressure generally. There were significant differences between specialty groups as well as regional differences. Specialists in two CHEs found dealing with management a major stressor. This finding is a major difference from previous overseas studies. CONCLUSIONS: Doing the job properly, having a job that seems worthwhile, having control of one's professional life and a job that is interesting provide the greatest sources of work satisfaction for medical specialists.

Data Collection↗
PubMed1993

Antibiotic protocol for appendicectomy--costs and benefits of single dose therapy.

AIMS: To examine possible savings from the introduction of an antibiotic protocol for one surgical procedure and to define antibiotic charting techniques. METHODS: An antibiotic policy for patients undergoing an appendicectomy was instituted in the surgical unit at North Shore Hospital to examine possible savings and to define antibiotic charting techniques. Depending on the macroscopic findings at surgery a third generation cephalosporin was used either as a single dose intraoperatively or for multiple doses postoperatively. RESULTS: The case notes of a control group of 55 patients were reviewed. This showed an average antibiotic cost per appendicectomy of $69.00 ($52.00) for nongangrenous nonperforated appendices (NGNPA). During the study period 57 patients underwent appendicectomy at an average antibiotic cost of $51.00 ($32.00 for NGNPA). This represented a 26% saving per patient during the study period and a 39% saving for those with NGNPA: CONCLUSIONS: The findings advocate the use of frequently updated guidelines for antibiotic use in surgical procedures. It reaffirms that medical staff must chart precisely as poor charting represents significant waste of expenditure in hospitals.

Anti-Bacterial Agents↗
PubMed1986

Age and sex differences in right colon cancer.

In a prospective study of 402 colorectal cancer patients, 133 patients (46 men and 87 women) presented with right colon cancer. There was no significant difference between men and women in right colon cancer incidence. Common presenting features were abdominal pain, weight loss, and anemia. Ninety-one patients underwent resection with curative intent. There were significantly fewer Dukes' A tumors in the right colon cancer series (P less than 0.05). Significantly more women in the right colon cancer group were over 70 years old (P less than 0.05). The findings of peritoneal metastases and poorly differentiated lesions at initial surgery also were associated significantly with women who had right colon cancer (P less than 0.05). This study confirms previous reports of more advanced tumors in the right colon. The need for age, sex, and subsite differences to be taken into account when assessing treatment outcomes or survival is emphasized.

Adenocarcinoma↗
PubMed1985

Large bowel cancer.

Explore the source record for details and available documents.

Colonic Neoplasms↗
PubMed1985

Colorectal cancer in Auckland 1981-1982: patients with liver metastases.

In a population-based study of 402 cases of colorectal cancer in Auckland, 72 patients (18%) demonstrated liver metastases either at presentation or at initial surgery. The findings of pre-operative weight loss, hepatomegaly and elevated alkaline phosphatase were significantly associated with heptic metastases. Individually these factors were insensitive indicators of the presence of liver metastases. Two or more of these risk factors were demonstrated by 54% of the patients with liver secondaries compared to 19% in the series without liver metastases. Continuing surveillance of the latter group of patients will show whether they are also at risk of developing liver secondaries. The median survival for the 69 patients who were diagnosed before death was 6.0 months. When the primary lesion was resected and the patient survived the post-operative period the median survival was 11.0 months.

Aged↗
PubMed1985

DNA-damaging activity in ethanol-soluble fractions of feces from New Zealand groups at varying risks of colorectal cancer.

Using repair-proficient and repair-deficient strains of E. coli, we investigated the application of a liquid incubation assay to measure the DNA-damaging activity of ethanol-soluble fecal extracts. This method appears to be suitable for the study of a wide range of sample types. It was used to measure the DNA-modifying activity of ethanol-soluble fecal extracts from a group of European colorectal cancer patients. Data were compared with those from Europeans of similar age and sex distribution who did not have bowel cancer. We also studied groups of Maoris, Samoans, and European Seventh-Day Adventists who followed an ovo-lacto vegetarian diet. There are significant levels of DNA-modifying materials in the feces of many Europeans on a mixed diet, regardless of whether or not they have cancer. The number of positive samples was less in the Polynesian groups, and there were no samples that could be unequivocally scored as positive in the Seventh-Day Adventist groups. We conclude that diet can significantly reduce the level of ethanol-soluble mutagens, at least in New Zealand Europeans. The data may provide an explanation for the reduced incidence of bowel cancer in Seventh-Day Adventist groups.

Adult↗
PubMed1984

Quantitation of free and conjugated bile acids in human feces using a high-pressure liquid chromatography counterion method.

A method has been developed for extraction and purification of the major bile acids in human feces, and for their quantitative estimation using high-pressure liquid chromatography. Freeze-dried fecal material was extracted with alkaline ethanol and, after removal of neutral steroids, was subjected to thin-layer chromatography, followed by reversed-phase C18 silica cartridge (Sep-Pak) purification. The mixture was further separated into free, and glyco and tauro conjugates by ion-exchange chromatography. Subsequent resolution of individual bile acids was accomplished by HPLC using a counterion pairing method.

Bile Acids and Salts↗
PubMed1983

The increased risk of proximal colonic cancer after cholecystectomy.

In a retrospective case control review we determined the cholecystectomy frequency of 479 index cases of colonic carcinoma and 479 age, sex, and admission date matched controls. The frequency distribution patterns of cholecystectomy with reference to subsite specific cancer of the large bowel were determined. The cholecystectomy frequency in patients with proximal colonic cancer was higher than those in whom cancer was present in areas other than the proximal colon (12.3 per cent vs. 6.6 per cent, P less than 0.02). There was a gradient of previous cholecystectomy history from the proximal colon to the rectum. The overall frequency of previous cholecystectomy in the index cases was 8.1 per cent while that in the matched control was 5.4 per cent. The difference was not statistically significant. However, the cholecystectomy frequency of the proximal colonic cancer subgroup was significantly higher than its matched control group (12.3 per cent vs. 4.6 per cent, P less than 0.02). The difference was greater in females with proximal colonic cancer compared with their matched controls (14.3 per cent vs. 3.6 per cent, P less than 0.02). Our data supported the hypothesis that either (1) altered bile salt metabolism after cholecystectomy may increase colonic cancer formation, or (2) gallbladder disease and colonic cancer may share common etiologic factors.

Cholecystectomy↗