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Biomedical subjects

R Lawton

Publications and source records attributed to R Lawton.

At least 19 recordsLinked to original sources
PubMed2005

Increasing daily fruit and vegetable consumption: what changes do cardiac patients make?

BACKGROUND: Interventions targeting fruit and vegetable consumption report significant increases in consumption but do not detail how increases are achieved. This prospective study explored (i) the changes in daily fruit and daily vegetable consumption of cardiac patients participating in an intervention study and (ii) how participants made these changes. METHODS: A total of 120 cardiac patients were asked to increase their daily fruit and vegetable consumption by two portions and to maintain this over 3 months. They were telephoned at 7-, 28- and 90-day follow-up to record daily consumption using a dietary questionnaire; 94 participants completed all parts of the study. RESULTS: Mean reported daily fruit and daily vegetable consumption increased by 1.07 (SD = 1.26) and 0.34 (SD = 0.96) portions, respectively, over 3 months. These increases were statistically significant (P < 0.001) and greatest for participants who reported eating low levels of fruit and vegetables at recruitment. Eating fresh fruit as a snack and at mealtimes were preferred choices for participants. CONCLUSIONS: Providing information and telephone follow-up could be used by busy healthcare professionals instead of face-to-face contact. Interventions to increase total fruit and vegetable consumption could usefully focus on eating fruit. Interventions to increase vegetable consumption need further investigation.

Female↗
PubMed2005

Making psychological theory useful for implementing evidence based practice: a consensus approach.

BACKGROUND: Evidence-based guidelines are often not implemented effectively with the result that best health outcomes are not achieved. This may be due to a lack of theoretical understanding of the processes involved in changing the behaviour of healthcare professionals. This paper reports the development of a consensus on a theoretical framework that could be used in implementation research. The objectives were to identify an agreed set of key theoretical constructs for use in (1) studying the implementation of evidence based practice and (2) developing strategies for effective implementation, and to communicate these constructs to an interdisciplinary audience. METHODS: Six phases of work were conducted to develop a consensus: (1) identifying theoretical constructs; (2) simplifying into construct domains; (3) evaluating the importance of the construct domains; (4) interdisciplinary evaluation; (5) validating the domain list; and (6) piloting interview questions. The contributors were a "psychological theory" group (n = 18), a "health services research" group (n = 13), and a "health psychology" group (n = 30). RESULTS: Twelve domains were identified to explain behaviour change: (1) knowledge, (2) skills, (3) social/professional role and identity, (4) beliefs about capabilities, (5) beliefs about consequences, (6) motivation and goals, (7) memory, attention and decision processes, (8) environmental context and resources, (9) social influences, (10) emotion regulation, (11) behavioural regulation, and (12) nature of the behaviour. CONCLUSIONS: A set of behaviour change domains agreed by a consensus of experts is available for use in implementation research. Applications of this domain list will enhance understanding of the behaviour change processes inherent in implementation of evidence-based practice and will also test the validity of these proposed domains.

Evidence-Based Medicine↗
PubMed2003

Psychological contribution to the understanding of adverse events in health care.

In the past it has sometimes been assumed in health care that all adverse events involve individual incompetence and therefore blameworthiness, an assumption that is likely to hinder the development of comprehensive and honest incident reporting systems. At the same time, a full understanding of adverse events in healthcare systems requires that distinctions are drawn between a variety of error types, each of which has different origins and demands different strategies for remediation. In this paper a range of cognitive biases identified by psychologists is described. Examples are given of these biases, which are naturally employed in trying to understand our own behaviour and that of others, and therefore affect our understanding of adverse events. It is suggested that awareness of these biases, which form part of our normal thinking, should help to avoid a narrow focus on individual culpability and facilitate a more sophisticated approach to the investigation of adverse events.

Adaptation, Psychological↗
PubMed2002

Barriers to incident reporting in a healthcare system.

BACKGROUND: Learning from mistakes is key to maintaining and improving the quality of care in the NHS. This study investigates the willingness of healthcare professionals to report the mistakes of others. METHODS: The questionnaire used in this research included nine short scenarios describing either a violation of a protocol, compliance with a protocol, or improvisation (where no protocol exists). By developing different versions of the questionnaire, each scenario was presented with a good, poor, or bad outcome for the patient. The participants (n = 315) were doctors, nurses, and midwives from three English NHS trusts who volunteered to take part in the study and represented 53% of those originally contacted. Participants were asked to indicate how likely they were to report the incident described in each scenario to a senior member of staff. RESULTS: The findings of this study suggest that healthcare professionals, particularly doctors, are reluctant to report adverse events to a superior. The results show that healthcare professionals, as might be expected, are most likely to report an incident to a colleague when things go wrong (F(2,520) = 82.01, p < 0.001). The reporting of incidents to a senior member of staff is also more likely, irrespective of outcome for the patient, when the incident involves the violation of a protocol (F(2,520) = 198.77, p < 0.001. It appears that, although the reporting of an incident to a senior member of staff is generally not very likely, particularly among doctors, it is most likely when the incident represents the violation of a protocol with a bad outcome. CONCLUSIONS: An alternative means of organisational learning that relies on the identification of system (latent) failures before, rather than after, an adverse event is proposed.

Attitude of Health Personnel↗
PubMed2001

The effect of vancomycin and third-generation cephalosporins on prevalence of vancomycin-resistant enterococci in 126 U.S. adult intensive care units.

BACKGROUND: Patient-specific risk factors for acquisition of vancomycin-resistant enterococci (VRE) among hospitalized patients are becoming well defined. However, few studies have reported data on the institutional risk factors, including rates of antimicrobial use, that predict rates of VRE. Identifying modifiable institutional factors can advance quality-improvement efforts to minimize hospital-acquired infections with VRE. OBJECTIVE: To determine the independent importance of any association between antimicrobial use and risk factors for nosocomial infection on rates of VRE in intensive care units (ICUs). DESIGN: Prospective ecologic study. SETTING: 126 adult ICUs from 60 U.S. hospitals from January 1996 through July 1999. PATIENTS: All patients admitted to participating ICUs. MEASUREMENTS: Monthly use of antimicrobial agents (defined daily doses per 1000 patient-days), nosocomial infection rates, and susceptibilities of all tested enterococci isolated from clinical cultures. RESULTS: Prevalence of VRE (median, 10%; range, 0% to 59%) varied by type of ICU and by teaching status and size of the hospital. Prevalence of VRE was strongly associated with VRE prevalence among inpatient non-ICU areas and outpatient areas in the hospital, ventilator-days per 1000 patient-days, and rate of parenteral vancomycin use. In a weighted linear regression model controlling for type of ICU and rates of VRE among non-ICU inpatient areas, rates of vancomycin use (P < 0.001) and third-generation cephalosporin use (P = 0.02) were independently associated with VRE prevalence. CONCLUSIONS: Higher rates of vancomycin or third-generation cephalosporin use were associated with increased prevalence of VRE, independent of other ICU characteristics and the endemic VRE prevalence elsewhere in the hospital. Decreasing the use rates of these antimicrobial agents could reduce rates of VRE in ICUs.

Anti-Bacterial Agents↗
PubMed2000

Judging the use of clinical protocols by fellow professionals.

The objective of this study was to investigate the judgements of British doctors, nurses and midwives about behaviour which complies with a protocol, violates a protocol, or constitutes an improvisation where no protocol exists. Primary data were collected on the judgments of hospital healthcare professionals (N = 310) from three specialties in each of three hospitals. Respondents were required to judge the appropriateness of the behaviour of a fellow professional in each of nine hypothetical scenarios generated on the basis of previous focus group discussions. They were also asked how likely they would be to report this professional to a senior member of staff. Within the scenarios, both behaviour with respect to the relevant clinical protocol and outcome for the patient were experimentally manipulated. Data were collected using a survey questionnaire. The three professional groups studied (doctors, nurses and midwives) were found to make significantly different judgements. Crucially, doctors judged the violation of a protocol as less inappropriate than did nurses or midwives. Midwives were disapproving of violations, even when the patient outcome was good. These differences were reflected in the ratings of reporting likelihood. The proliferation of clinical protocols likely to occur in Britain in the coming years will need to be managed with great care if the regulation of clinical behaviour is the goal. Particular care will be needed to avoid the exacerbation of professional tensions.

Anesthesiology↗
PubMed2000

Ability of laboratories to detect emerging antimicrobial resistance in nosocomial pathogens: a survey of project ICARE laboratories.

A proficiency testing project was conducted among 48 microbiology laboratories participating in Project ICARE (Intensive Care Antimicrobial Resistance Epidemiology). All laboratories correctly identified the Staphylococcus aureus challenge strain as oxacillin- resistant and an Enterococcus faecium strain as vancomycin-resistant. Thirty-one (97%) of 32 laboratories correctly reported the Streptococcus pneumoniae strain as erythromycin-resistant. All laboratories testing the Pseudomonas aeruginosa strain against ciprofloxacin or ofloxacin correctly reported the organism as resistant. Of 40 laboratories, 30 (75%) correctly reported resistant MICs or zone sizes for the imipenem- and meropenem-resistant Serratia marcescens. For the extended-spectrum beta-lactamase (ESBL)-producing strain of Klebsiella pneumoniae, 18 (42%) of 43 laboratories testing ceftazidime correctly reported ceftazidime MICs in the resistant range. These results suggest that current testing generally produces accurate results, although some laboratories have difficulty detecting resistance to carbapenems and extended-spectrum cephalosporins. This highlights the need for monitoring how well susceptibility test systems in clinical laboratories detect emerging resistance.

Aminoglycosides↗
PubMed1999

Procedures and the professional: the case of the British NHS.

The introduction of procedures to guide medical practice is a growing phenomenon in the British National Health Service. It is thought to be a useful way of managing risk, standardising practice and ensuring that research evidence is incorporated into patient care. However, the mere development and introduction of procedures does not ensure that they are actually followed. In the research reported here focus group methodology was used to investigate the perceptions and opinions of doctors, nurses, midwives and health service managers. Twenty-four focus groups were convened across three hospitals, with discussion focusing on the purpose, development and implementation of clinical protocols. The effect of proceduralisation on professional autonomy and on the working relationships among professional groups also emerged as important themes. The paper concludes that successful implementation of protocols or guidelines in the NHS depends on achieving the right balance between standardising practice and allowing professionals to use clinical judgement. Successful implementation of clinical guidelines also requires that the culture of the health service and the beliefs, attitudes and norms of its employees are taken into account.

Attitude of Health Personnel↗
PubMed1995

Expression and secretion of parathyroid hormone-related protein by human bone-derived cells in vitro: effects of glucocorticoids.

We investigated the production of parathyroid hormone-related protein (PTHrP) by cells derived from explants of human bone. Using an immunoradiometric assay (IRMA), PTHrP was detected in conditioned medium from cultures of bone-derived cells from 6 of 7 patients investigated in this study. PTHrP mRNA was identified in human bone cells using reverse transcriptase-linked polymerase chain reaction (RT-PCR) and by Northern analysis. Transcripts for PTHrP were detected in a purified population of alkaline phosphatase positive cells isolated from human bone marrow cultures by flow cytometry, confirming the expression of PTHrP mRNA by cells of the osteoblastic lineage. Production of PTHrP was inhibited by 10(-6) M of the glucocorticoids, prednisolone and desacetylated deflazacort, in a dose-dependent manner. In addition, RT-PCR followed by Southern blot analysis detected a decrease in steady-state PTHrP mRNA in cultures of human bone-derived cells treated with 10(-6) M prednisolone.

Adolescent↗
PubMed1994

Primary cultures of human bone-derived cells produce parathyroid hormone-related protein: a study of 40 patients of varying age and pathology.

Parathyroid hormone-related protein (PTHrP), a mediator of hypercalcemia of malignancy, has been detected in many tumours and in some normal foetal and adult tissues. PTHrP has potent effects on bone turnover in vivo and in vitro. In this study we cultured cells derived from explants of bone obtained from 40 subjects (age range 2-88 years). Immunoreactive PTHrP (iPTHrP) was detected by immunoradiometric assay (IRMA) in conditioned medium from 25 of 40 cultures of bone-derived cells. PTHrP mRNA was detected in bone-derived cells by reverse transcriptase-linked polymerase chain reaction (RT-PCR). The identity of PCR products was confirmed by Southern blotting. Local production of PTHrP in vivo may be important in the regulation of bone growth and remodelling.

Adolescent↗
PubMed1993

Evaluation and management of acute uvular edema.

Acute uvular edema is a potentially life-threatening condition with a variety of causes. Other upper airway structures, most notably the epiglottis, may also become involved, and complete or partial airway obstruction may ensue rapidly. An accurate diagnosis may be essential in establishing effective treatment.

Acute Disease↗
PubMed1993

Clinical and laboratory studies of a new immunoradiometric assay of parathyroid hormone-related protein.

Parathyroid hormone-related protein (PTHrP) was measured in plasma by a new immunoradiometric assay (IRMA) from Nichols Institute. The assay is specific for PTHrP and shows excellent parallelism when measuring keratinocyte fluid, samples with high PTHrP content, and PTHrP-supplemented plasma. A precision profile established the assay detection limit at 0.7 pmol/L. PTHrP was unstable in plasma, but the degradation rate was patient-specific. Because delay in separation resulted in loss of PTHrP immunoreactivity, samples were collected into tubes containing protease inhibitors (aprotinin, leupeptin, pepstatin, and EDTA) and separated within 30 min. Among normal subjects, 78% had PTHrP values greater than the detection limit; the reference range established was < 0.7-2.6 pmol/L. Of patients with hypercalcemia associated with malignancy, 46% had PTHrP > 2.6 pmol/L. PTHrP was increased in patients with breast (73%), genitourinary (64%), or lung (46%) malignancy but was rarely above normal in patients with hematological (29%) or gastrointestinal (33%) malignancy. PTHrP and nephrogenous cyclic adenosine monophosphate (NcAMP) were strongly correlated (r = 0.63, P < 0.01) in 37 patients with PTHrP values greater than the detection limit, but 8 patients had PTHrP and parathyroid hormone [PTH(1-84)] values below the limit of detection with inappropriate or increased NcAMP. Five of these eight patients had small cell carcinoma of lung. These patients may have secreted a factor that is not detected by the IRMAs of PTHrP or PTH used in this study but that produces hypercalcemia by means of cAMP-mediated mechanisms.

Adult↗
PubMed1989

Hyperalimentation with atherosclerosis reversal.

The authors discuss management of a patient treated for 7 months with total central parenteral nutrition, using hypertonic glucose and aminoacids. Previous disease accounted in part for failure of the pulmonary, cardiac, renal and gastrointestinal system.

Amino Acids↗
PubMed1989

Two stages of care for pleural effusion.

When the patient's pleural space is filled with fluid, palliative treatment measures--thoracic drainage and pleurodesis--and diligent nursing care can help her breathe easier.

Drainage↗
PubMed1983

Reaction of 2-thio-FAD-reconstituted p-hydroxybenzoate hydroxylase with hydrogen peroxide. Formation of a covalent flavin-protein linkage.

Hydrogen peroxide reacts with 2-thio-FAD-reconstituted p-hydroxybenzoate hydroxylase to yield a long wavelength intermediate (lambda max = 360, 620 nm) which can be isolated in stable form on removal of excess H2O2. The blue flavin derivative slowly decays in a second peroxide-dependent reaction to yield a new flavin product lacking long wavelength absorbance (lambda max = 408, 472 nm). This final peroxide-modified enzyme binds p-hydroxybenzoate with a 10-fold lower affinity than does the native enzyme; furthermore, substrate binding leads to the inhibition of enzyme reduction by NADPH. Trichloroacetic acid treatment of the final peroxide-modified enzyme results in the quantitative conversion of the bound flavin to free FAD. However, gel filtration of the modified enzyme in guanidine hydrochloride at neutral pH leads to the co-elution of protein and modified flavin. The nondenatured peroxide product reacts rapidly with hydroxylamine to yield 2-NHOH-substituted FAD. These observations indicate that the secondary reaction of peroxide with the blue intermediate from 2-thio-FAD p-hydroxybenzoate hydroxylase results in the formation of an acid-labile covalent flavin-protein linkage within the enzyme active site, involving the flavin C-2 position.

4-Hydroxybenzoate-3-Monooxygenase↗
PubMed1981

Racial differences in perception of ward atmosphere.

The authors administered the Moos Ward Atmosphere Scale (WAS) to 17 black inpatients and 17 white inpatients at a VA hospital. Scores on 5 of the 10 subscales reflected significant differences on the basis of race. From these results, the authors assume that black patients and white patients perceive the same ward environment differently. They briefly discuss the treatment implications of such perceptual differences.

Adult↗