Primary care in Bradford: from group to trust and beyond.
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England↗
Biomedical subjects
S Proctor
Publications and source records attributed to S Proctor.
Putting portfolios in their place.
This paper discusses the use of portfolios in nursing education and sets this in an international context. It argues that the assessment of clinical competence in the practice setting is inherently problematic, as recognized in certain recent policy documents, and evaluates the role that portfolios can play. A number of theoretical approaches to the definition and use of portfolios are discussed, and particular attention is paid to their reliability and validity as assessment tools. The paper concludes by arguing that there is a need for further research into the credibility, reliability and validity of this approach to the assessment of nurses' competence.
Clinical Competence↗
Improving general practitioners' assessment and management of suicide risk.
Standards for assessing and managing suicide risk were developed and incorporated into a guidance manual for general practitioners. The effects of the manual on opinions and practice were evaluated using a quasi-experimental controlled before/after design, comparing participating general practitioners with others who did not use the manual. Thirty four general practitioners participated over a six-month period. The intervention group showed changes in perceptions, with increased satisfaction with their own methods and in their recognition and assessment of suicide risk. Their practice changed, with increased recording of relevant factors in notes. The comparison group did not change in these ways. It is concluded that general practitioners' practice and opinions in assessing and managing suicide risk were significantly improved using a minimal intervention. Given the importance of the topic and the small size of this study, further research is needed, examining changes in professional practice, knowledge and attitudes.
Affective Symptoms↗
Detection of Epstein-Barr virus (EBV) genomes in the serum of patients with EBV-associated Hodgkin's disease.
DNA from malignant cells is present in the serum/plasma of cancer patients and DNA from this source is amenable to analysis by polymerase chain reaction (PCR). In the present study, we evaluated whether Epstein-Barr virus (EBV) DNA is present in the serum of patients with EBV-associated Hodgkin's disease (HD). Using conventional PCR, EBV DNA was detected in serum from 30/33 patients with EBV-associated HD but in only 6/26 patients with non-EBV-associated disease (p < 0.001). Samples from healthy individuals were negative and only 5/12 infectious mononucleosis samples were positive. Real-time quantitative PCR was subsequently employed to determine the concentration of EBV DNA present in serum; among positive samples the level ranged from 1 to 705 copies per 125 microliter of serum. Post-treatment samples from 5/14 cases with EBV-associated HD contained detectable EBV DNA; analysis of this small group of cases suggests that positivity in post-treatment samples correlates with risk factors indicative of a poor prognosis. Overall, our results are consistent with the notion that DNA from Reed-Sternberg cells is present in the serum of HD patients, and further suggest that serum EBV should be evaluated as a prognostic marker. Int. J. Cancer (Pred. Oncol.) 84:442-448, 1999.
Adult↗
Use of a skin explant model for predicting GVHD in HLA-matched bone marrow transplants - effect of GVHD prophylaxis.
Over the last decade we have successfully evaluated the use of a human skin explant assay for predicting acute GVHD in HLA-matched sibling transplants. In the present study, we modified GVHD prophylaxis on an individual patient basis depending on the GVHD outcome predicted by the skin explant model. We have summarised our previous data describing how the skin explant assay results correctly predict GVHD occurrence and severity in 45/56 patients (80%); P< 0.0001, chi2 19.97, df = 1. In a further cohort of 19 patients, all were predicted to develop grade II or above GVHD. These patients were given increased GVHD prophylaxis with the addition of methotrexate and a significant reduction in the expected incidence of GVHD was observed (P = 0.02; chi2 7.7, df = 1; Fisher exact test P = 0.04). The results from these studies suggest that modifying GVHD prophylaxis, based on skin explant assay results, may reduce the expected incidence and severity of GVHD. We suggest that the technique might be used for selective GVHD prophylaxis in T cell non-depleted HLA matched sibling transplants.
Adolescent↗
A developmental performance framework for primary care.
Primary care in the NHS changed substantially during the 1990s. In recent years, structural changes, most notably the introduction of primary care groups as an administrative centre for planning, have added impetus to the need for adopting meaningful measures of quality of the primary care service. This qualitative study reports the views of a sample of general practitioners, primary care nurses, and practice managers on the development and refinement of current performance indicators. Seven themes were identified as key areas for development of indicators of performance: patient experience, clinical activity, service development and innovation, access, health promotion, cost effectiveness, and quality of life outcomes. These themes are incorporated into a dynamic framework for development where improved outcomes (including quality of life measures) are seen as central to the evaluation of quality, and inter-professional collaboration in the delivery and evaluation of quality of the new primary care is called for.
Attitude of Health Personnel↗
Development of a brief questionnaire for screening for multiple chemical sensitivity syndrome.
The objective of this study was to identify a parsimonious set of questions that has high sensitivity and specificity for screening for individuals with multiple chemical sensitivity (MCS) syndrome. We performed a cross-sectional survey using a case-control design. Subjects were derived from patients seen at an academically based Occupational and Environmental Medicine Clinic. Cases consisted of patients who fulfilled the Cullen definition for MCS. Controls were patients who had diagnoses excluding MCS and asthma and who were matched to cases by age and sex. Cases and controls filled out a screening questionnaire that, among things, elicited responses as to whether and how subjects reacted to 122 different types of environmental exposures. Data from 44 pairs of cases and controls were available for analysis. The average age of cases was 50.2 years, and 91% was female. Among cases, the most common exposure that was purported to incite MCS was 'indoor air quality contaminants (unspecified)' (59%), followed by solvents (27.3%). After randomly excluding five cases and controls, a stepwise selection procedure for two-group discriminant analysis revealed that the main contributors to the discrimination of the remaining cases and controls were self-reported reactions to copy machine emissions, marking pens, aftershave, window cleaner, nylon fabric, pine-scented products, and rayon material. When a positive response to these factors was used as the sole method for discriminating cases from controls, only one of 41 cases was misclassified as a control while none of the controls was misclassified as a case. When the same method was applied to the five excluded cases and five excluded controls, only one of the five cases was misclassified while none of the five controls was misclassified as a case. Among patients with MCS defined by the Cullen criteria in this clinical setting, having a reaction to these seven common potential exposures comprised a parsimonious set of factors that discriminated between MCS patients and age- and sex-matched normal controls. These questions may have utility in screening for individuals with MCS in general population survey studies.
Air Pollution, Indoor↗
Using women's views to inform and develop quality in midwifery.
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Attitude to Health↗
A strong expression of CD44-6v correlates with shorter survival of patients with acute myeloid leukemia.
CD44 is a ubiquitous cell-surface glycoprotein that displays many variant isoforms (CD44v) generated by alternative splicing of exons 2v to 10v. The expression of variant isoforms is highly restricted and correlated with specific processes, such as leukocyte activation and malignant transformation. We have herein studied CD44v expression in acute myeloid leukemia (AML) and, for comparison, in normal myelopoiesis. Protein expression of total CD44 and of CD44-3v, -6v, and -9v isoforms has been measured using specific monoclonal antibodies and flow cytometry. The composition of variant exon transcripts has been analyzed by semi-quantitative reverse transcriptase-polymerase chain reaction followed by Southern hybridization with exon-specific probes. Our data show that (1) CD44-6v isoforms are expressed on 12.0% +/- 2.5% of normal CD34(+) cells; this expression is sharply upregulated through monopoiesis and, inversely, downregulated during granulopoiesis. Also, CD44-3v and CD44-9v isoforms are detected on 10% and 14% of normal monocytes, respectively. (2) Sixty-nine from a total of 95 AML patients display a variable proportion (range, 5% to 80%) of CD44-6v+ leukemic cells. (3) A shorter overall survival characterizes the group of AML patients displaying more than 20% of CD44-6v+ leukemic cells (8 months v 18 months, P < .02). These data suggest, for the first time, that the protein expression of CD44-6v containing isoforms may serve as a new prognostic factor in AML.
Acute Disease↗
What determines quality in maternity care? Comparing the perceptions of childbearing women and midwives.
BACKGROUND: In the current climate of consumer orientation in health care services, a clear need has emerged to understand the extent of consumer focus among primary health care professionals. Few studies have compared the beliefs of health care staff with those of patients. This study sought to identify and compare the perceptions of women and midwives concerning women's beliefs about what constitutes quality in maternity services. METHODS: Focus groups were conducted from July 1994 to June 1997 with 38 pregnant and postnatal women, and 47 midwives who were based in two large maternity units in Yorkshire, England. Transcriptions of data were analyzed to identify broad themes. RESULTS: Ten dimensions of quality were identified. Similarities between midwives and women included beliefs about the importance of the relationship between the two parties, desired attributes of staff, and the environment of care. Key differences included underestimating the importance of information antenatally and postnatally, the importance of continuity during labor, need for control and confidence in adjusting to the maternal role, and involvement of the woman's partner in the delivery of care. CONCLUSIONS: An understanding of the concerns of women by maternity care staff is important in the development of a woman-focused service, in line with current policy recommendations, and has implications for risk management and improving the service quality for those who provide and experience the service.
Adult↗
Consumer responses to health care: women and maternity services.
The importance of understanding consumer perceptions of services is widely acknowledged. This is becoming more relevant in health care, as attempts to incorporate users' views into service development and evaluation are increasing. This study focused on women's responses to their recent experience of maternity care, and sought to gain insight into the service features they associated with negative and positive reactions. Postal questionnaires were sent to antenatal and postnatal women. Two open questions invited women to note if any aspects of their care had particularly impressed or bothered them. There was variation in the factors identified through the different phases of the service--antenatal, labour and postnatal care. However, staff attitudes were a main source of positive comments throughout the service, and lack of information and poor explanations were a consistent source of negative responses. Providing consumers with an opportunity to give feedback on their service experience should be based on issues which are relevant to them, not just on those which are measurable.
Female↗
Is this the end of research as we know it?
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Population Surveillance↗
Alpha interferon gene deletions in post-transplant lymphoma.
Post-transplant lymphoproliferative disorder (PTLD) is a well-recognized complication of organ transplant and has been associated with high mortality using conventional chemotherapy. We have investigated 11 cases of PTLD for alterations to the interferon alpha (IFNA) and p16 genes on chromosome 9p using archival material. 4/9 (44%) cases had deletions of the IFNA genes, in contrast to 1/59 (1.7%) cases of intermediate/high-grade de novo NHL drawn from the same geographical region. PTLD may therefore represent a distinct NHL subgroup exhibiting distinct gene pathology.
Chromosomes, Human, Pair 9↗
International population and development: the United Nations' Cairo Action Plan for women's health.
The report of the International Conference on Population and Development (Cairo Action Document) was sponsored by 180 national governments and 1,200 nongovernmental organizations during the United Nations' conference on women, population, and development in Cairo, Egypt 1994. Many international conferences preceded the one in Cairo but it was there that women participated at an unprecedented level in shaping the debate. The resulting document represents a quantum leap for women's health. Nurses can play a major role in using the principles in the Cairo Action Document by empowering women and enhancing their health care. To invite dialogue, the authors provide an analysis of the Cairo Plan from a nursing perspective and identify three paradoxes that may hinder progress: Universal values and local cultures, global policy and local implementation, and national development and women's empowerment. Clinicians, scholars, and members of professional organizations are asked to consider the assumptions that underlie the recommendations for action and to propose ways to resolve the problems that may evolve during implementation.
Egypt↗
Matching versus cultural competence in research: methodological considerations.
Researcher/participant matching has been used in nursing research as a strategy for the development of culturally competent knowledge. In this manuscript, the complexities inherent in matching in nursing research are discussed. In raising and discussing issues and questions related to matching, we argue that although matching may be one of the strategies used to generate culturally competent knowledge, it is frequently too complex for operationalization. Therefore, we propose that researchers reflect on questions related to their knowledge of culture, their cultural sensitivity, and the nature of collaboration during every phase of the research. Reflecting on and responding to these questions in every research project may facilitate the development of more culturally competent knowledge.
Cultural Diversity↗
Is it possible to catch leukaemia from a cat?
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Animals↗
Neuropsychological effects of exposure to naphtha among automotive workers.
The association between exposure to naphtha and neurobehavioural measures was examined prospectively over one year among workers employed at an automotive plant that used naphtha to calibrate fuel injectors. The neurobehavioural tests included those that assess mood, basic intelligence, and functioning of the cerebral frontal lobes and limbic system and were designed so that acute, reversible, and chronic effects of solvent exposure could be assessed. Participants were 248 workers in June 1988, and the testing was repeated on 185 of these workers in 1989. Concentrations of naphtha at the plant ranged from six to 709 mg/m3, although exposure was greater in 1988 than in 1989. Duration of exposure for individual subjects ranged from 0.8 to 7.3 years. Cross sectional data analyses showed significant associations between level of exposure to naphtha and slower timed scores on trails A, and greater reports of negative affective symptoms on profile of mood states scales in 1988 but not 1989. Threshold model analyses of the 1989 data showed an association between score on visual reproductions immediate recall and daily exposure to naphtha at or above 1050 h x mg/m3. Models of chronic exposure showed no associations between chronic exposure and negative neurobehavioural outcome. Results suggest that naphtha produces mild acute reversible effects on function of the central nervous system at or above daily exposures of 540 h x mg/m3 (approximately 90 ppm/h).
Adult↗
Residual cognitive deficits 50 years after lead poisoning during childhood.
The long term neurobehavioural consequences of childhood lead poisoning are not known. In this study adult subjects with a documented history of lead poisoning before age 4 and matched controls were examined with an abbreviated battery of neuropsychological tests including measures of attention, reasoning, memory, motor speed, and current mood. The subjects exposed to lead were inferior to controls on almost all of the cognitive tasks. This pattern of widespread deficits resembles that found in children evaluated at the time of acute exposure to lead rather than the more circumscribed pattern typically seen in adults exposed to lead. Despite having completed as many years of schooling as controls, the subjects exposed to lead were lower in lifetime occupational status. Within the exposed group, performance on the neuropsychological battery and occupational status were related, consistent with the presumed impact of limitations in neuropsychological functioning on everyday life. The results suggest that many subjects exposed to lead suffered acute encephalopathy in childhood which resolved into a chronic subclinical encephalopathy with associated cognitive dysfunction still evident in adulthood. These findings lend support to efforts to limit exposure to lead in childhood.
Cognition Disorders↗