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Biomedical subjects

T Kendrick

Publications and source records attributed to T Kendrick.

At least 37 records · Page 2Linked to original sources
PubMed1999

The newer, 'atypical' antipsychotic drugs--their development and current therapeutic use.

General practitioners (GPs) need to become more aware of a new generation of antipsychotic drugs that are 'atypical' in that, unlike traditional neuroleptics, they do not cause extrapyramidal side-effects; they may also be more effective against both the positive and negative symptoms of schizophrenia by their actions on various neurotransmitter pathways in the brain. This is a non-systematic review of the development of these new drugs and outlines how they are currently being used. It includes information found from an electronic search of the databases MEDLINE (from 1966 to June 1998) and EMBASE (from 1980 to January 1998) using the combined search terms 'antipsychotic agents', 'atypical', and 'schizophrenia'.

Antipsychotic Agents↗
PubMed1998

Randomized controlled trial of teaching practice nurses to carry out structured assessments of patients receiving depot antipsychotic injections.

BACKGROUND: A third of patients with schizophrenia are out of contact with secondary services. Many of these patients receive maintenance medication as depot antipsychotics from practice nurses, most of whom have negligible training in mental health. AIM: To examine the impact of a structured assessment on the process of care and clinical status of schizophrenia patients by practice nurses who received a one-day training course. METHOD: All identified patients were randomly allocated to structured assessments and outcome, measured by the number of assessments and the changes in care recorded in primary care notes. A comprehensive assessment of clinical and social functioning and level of unmet need in intervention and control patients was carried out after one year by an independent researcher. RESULTS: A high rate of consultation and clinical need in this patient group was demonstrated. Practice nurses were more diligent in carrying out assessments than general practitioners (GPs), but there was no impact on treatment patterns or clinical outcome. CONCLUSIONS: Structured assessments by practice nurses are feasible with this patient group, but training, targeted at both nurses and GPs, is needed if this intervention is to translate into health gain.

Adolescent↗
PubMed1998

Readiness to change health behaviours among patients at high risk of cardiovascular disease.

OBJECTIVE: To determine readiness to change dietary intake of fat, physical exercise and smoking, using a classification based on the stages of change model, among patients in a primary care population selected to have greater than normal risk of coronary heart disease. METHODS: We recruited 883 patients from general practices in the south of England who had one or more of the following cardiovascular risk factors: current cigarette smoking, total cholesterol level 6.5-9.0 mmol/l and a body mass index of 25-35 kg/m2 coupled with a lack of regular physical exercise. Measures of cardiovascular risk factors were obtained, together with questionnaire measures of stage of readiness to change smoking behaviour, dietary intake of fat and level of physical exercise. RESULTS: Patients with high cholesterol levels had a different degree of readiness to reduce dietary fat from that of those with low cholesterol levels. Patients who were overweight and inactive reported a greater readiness to increase their physical activity than did those who were not overweight and not inactive. Readiness to change any of the three behaviours was not affected by the presence of more than one modifiable risk factor. However, patients who were contemplating or preparing to stop smoking were also more ready to increase physical activity than were those who were not considering stopping smoking. CONCLUSIONS: Risk classification has an impact upon patients' readiness to change modifiable cardiovascular risk behaviours. The relationships between readiness to change various behaviours suggest that there are synergies in counselling strategies and methods of identifying patients who might be especially responsive.

Adolescent↗
PubMed1998

Bereavement care in general practice: a survey in South Thames Health Region.

BACKGROUND: Studies have shown that bereaved individuals suffer increased rates of physical and mental ill health. Bereavement support has recently been advocated as an area of prevention in primary care, with suggestions that general practitioners (GPs) should adopt protocols for the active follow-up of their bereaved patients, which relies on the early notification of deaths by hospitals and hospices. Little is known about the routine care currently provided by GPs and primary health care teams (PHCTs) to support their bereaved patients. AIMS: To explore GPs' perceptions of patient death notifications by hospitals and hospices. To describe practice policies relating to patient deaths and the provision of bereavement support. METHOD: Postal questionnaires were sent to senior partners of a random sample of 500 general practices in South Thames Health Region. RESULTS: Three hundred and fifty-three practitioners responded (71%). Hospitals were perceived to be significantly slower than hospices in notifying deaths (P < 0.0001). One hundred and ninety-six practices (56%) kept death registers, 230 (65%) discussed deaths together, and 142 (40%) identified bereaved relatives. One hundred and thirty-seven practices (39%) routinely offered bereaved relatives contact with a PHCT member; while 133 (38%) supported only those who asked for help. Routine support was significantly more likely to be provided by practices that kept a death register, discussed deaths together, identified bereaved relatives, and had a special interest in palliative care. CONCLUSIONS: GPs perceive hospitals to be slower than hospices at notifying deaths, particularly in the first 24 hours. They are divided over whether bereavement support should be proactive or reactive. Keeping a practice death register, discussing deaths together, and identifying newly bereaved relatives are activities related to providing routine bereavement care.

Attitude of Health Personnel↗
PubMed1997

Care of long-term mentally ill patients by British general practitioners.

In the United Kingdom, patients gain access to psychiatric care through general practitioners (GPs). The first of three studies conducted to assess the role of GPs in managing patients with long-term mental illness found that such patients were unevenly distributed in general practices and that GPs preferred to care for them in collaboration with psychiatric specialists. A more detailed study of 16 general practices yielded information on characteristics and care of long-term mentally ill patients, including a high rate of GP consultations for them. A third, controlled study examined the impact of teaching GPs to provide a structured assessment of long-term mentally ill patients every six months; after the intervention, only a small number of patients actually received such assessments.

Antipsychotic Agents↗
PubMed1997

The primary care of patients with schizophrenia: a search for good practice.

The proportion of patients with schizophrenia who lose contact with the secondary services is between 25% and 40%. The general practitioner remains the health care professional most likely to be in contact with such patients. A consensus group of 14 members met on four occasions, reviewed the relevant literature, and developed good-practice guidelines in five areas: establishing a register and organizing regular reviews; comprehensive assessments; information and advice for patients and carers; indications for involving specialist services; and crisis management. The guidelines are presented and their supporting evidence summarized.

Consensus Statements as Topic↗
PubMed1996

Soluble MHC II-peptide complexes induce antigen-specific apoptosis in T cells.

Soluble major histocompatibility (MHC) class II molecules in association with antigenic peptide recognize T cell receptors (TCRs) on CD4+ T cells. Such recognition of MHC II-peptide complexes by T cells in the absence of costimulatory signals is known to induce T cell nonresponsiveness. The present study describes that recognition of TCRs by MHC class II-peptide complexes induces antigen-specific apoptosis in a T cell clone independently of nonresponsiveness. Apoptosis was demonstrated in a murine T cell clone (4R3.9) restricted for IAk in association with a peptide analog of myelin basic protein [MBP(1-14)A4]. A dose- and time-dependent T cell death was observed upon incubation of 4R3.9 T cells with purified IAk-MBP(1-14)A4 complexes. The specificity of T cell apoptosis was shown by incubating 4R3.9 T cells with irrelevant IAs-MBP(90-101) complexes. The DNA fragmentation as a result of apoptosis was demonstrated by agarose gel electrophoresis and by pulsing T cells with BrdU followed by the detection of BrdU-labeled DNA fragments using an antibody enzyme-linked immunosorbent assay. The expression level of two regulatory intracellular proteins, bcl-2 and bax, involved in apoptosis showed a decrease in bcl-2 and an increase in bax with time. Finally, the nuclear shrinkage and chromatin condensation, typical hallmark of apoptosis, have been demonstrated by transmission electron microscopy of complex-treated T cells. Since the T cell clone (4R3.9) used in this study failed to show nonresponsiveness by IAk-MBP(1-14)A4 complexes, our results suggest that apoptosis induced by purified MHC class II-peptide complexes may involve distinct pathways rather than T cell nonresponsiveness. Such antigen-specific apoptosis may have significant clinical relevance in deleting autoreactive T cells in various autoimmune diseases.

Amino Acid Sequence↗
PubMed1996

Cardiovascular and respiratory risk factors and symptoms among general practice patients with long-term mental illness.

BACKGROUND: In the past, psychiatric in-patients suffered increased cardiovascular and respiratory mortality. The present study investigated whether increased risks persist among patients in the community and are being addressed in general practice. METHOD: A survey of 101 long-term mentally ill adults in 16 general practices in the South Thames (West) Region. RESULTS: Twenty-six patients were found to be obese (body mass index > 30 kg/m2), 53 were current smokers and 11 were hypertensive (mean systolic blood pressure > 160 mmHg or mean diastolic blood pressure > 100 mmHg, or both). Twenty-one reported daily cough and sputum, 24 shortness of breath, 11 wheezing and seven chest pain on exertion. These rates were significantly higher than population rates in a contemporary national survey. Nearly all the risk factors were recorded in the general practice records but few attempts to intervene were apparent. CONCLUSIONS: Long-term mentally ill patients remain at increased risk of cardiovascular and respiratory problems in the community. Primary care teams should make special efforts to tackle risk factors among this group.

Adult↗
PubMed1995

Randomised controlled trial of teaching general practitioners to carry out structured assessments of their long term mentally ill patients.

OBJECTIVE: To assess the impact of teaching general practitioners to carry out structured assessments of their long term mentally ill patients. DESIGN: Randomised controlled trial. SETTING: Sixteen group general practices in South Thames (west) region. SUBJECTS: 440 adults disabled by long term mental illness. INTERVENTIONS: Patients were identified by using practice data with help from local psychiatric and social services. In eight practices the practitioners were taught a structured assessment schedule to use with patients every six months for two years. MAIN OUTCOME MEASURES: Changes in drug treatments, referrals, consultation rates, and recording of preventive health data in the two years after intervention. RESULTS: Follow up data were available on 373 patients (84.7%). At least one structured assessment was recorded for 127 patients in the intervention group but only 29 had four assessments recorded. Participating practitioners considered the structured assessment to be time consuming and reported that it did not often lead directly to changes in treatment or referrals. Changes in treatment with neuroleptic drugs and referrals to community psychiatric nurses, however, were significantly more frequent in the intervention group (differences for intervention group minus control group adjusted for activity in two years before intervention were 14.3% (95% confidence interval 4.3% to 24.33%; P < 0.01) for neuroleptic drugs and 13.3% (2.0% to 24.6%; P < 0.05) for referrals). There were no significant differences in psychiatric admissions, use of the Mental Health Act, drug overdoses, prescriptions, referrals or admissions for physical problems, consultation rates, continuity of care, or recording of preventive data. CONCLUSIONS: Teaching general practitioners about the problems of long term mentally ill patients may increase their involvement in patients' psychiatric care. Regular structured assessments do not seem feasible in routine surgery appointments. More training for general practitioners and increased resources such as more nurse time may be necessary if improvements in care of long term mentally ill patients in general practice are to be generalised.

Adult↗
PubMed1994

Separation of complexes of major histocompatibility class II molecules and known antigenic peptide by metal chelate affinity chromatography.

A small fraction of affinity-purified MHC class II molecules are known to bind antigenic peptides in vitro. No simple method with acceptable recovery exists for separation of complexes of a known antigenic epitope and MHC class II from empty MHC class II and complexes of MHC class II and endogenously bound peptide. Here we describe an one step metal chelate affinity chromatography method to purify complexes of MHC class II and antigenic peptide of known composition. Complexes of human HLA-DR2 (DRB1*1501/DRB5*0101) and a peptide analog from human myelin basic protein MBP(84-102) containing a 6 histidine tag (6 x His) and a tyrosine residue at the N-terminus end [6 x His-MBP(83-102)Y83] were prepared and purified. The absence of residual free 6 x His-MBP peptide in the complex preparations were confirmed by gel filtration and TLC analyses. The purified complexes were applied onto Ni2+.nitrilotriacetic acid (Ni2+.NTA)-agarose affinity support and 6 x His-tagged peptide class II complexes were selectively eluted with imidazole-containing buffer. The quantitation of bound peptide in the eluted complexes showed 100% occupancy of HLA-DR2 (DRB1*1501/DRB5*0101) with [6 x His-MBP(83-102)Y83] peptide with a recovery of 50-75%. The presence of a single peptide entity in the eluted complexes was confirmed by reverse-phase narrowbore HPLC analysis of the acid-extracted supernatant and by amino acid sequencing analyses. As expected, no endogenous polypeptide was detected in the Ni2+.NTA eluted complexes when analyzed by two-dimensional IEF gel electrophoresis. Finally, we demonstrate that both MBP(84-102) and [6 x His-MBP(83-102)Y83] peptides were equally capable of stimulating restricted T cell line in the presence of autologous antigen presenting cells (APCs). These results demonstrate that metal chelate affinity chromatography can be used to prepare MHC class II-peptide complexes containing single peptide. Such complexes of class II molecules containing known peptide have significant clinical relevance for antigen-specific therapy of various autoimmune diseases and may provide better understanding of the trimolecular interaction between MHC class II, antigenic peptide and T cell receptor (TCR).

Amino Acid Sequence↗
PubMed1994

Provision of care to general practice patients with disabling long-term mental illness: a survey in 16 practices.

BACKGROUND: Increasing numbers of long-term mentally ill people now live in the community, many of whom lose contact with psychiatric services and come to depend on general practitioners for medical care. However, it has been suggested that general practitioners may be unaware of some of these patients and their needs. AIM: This study set out to investigate the care received by this group of patients. METHOD: Case registers of adults disabled by long-term mental illness were set up in 16 of 110 group general practices asked to participate. A search of each practice's record systems was combined with a survey of local psychiatric and social service teams, to seek practice patients who might not be identified from the general practice data. RESULTS: Of the 440 patients found, 90% were identified from information within the practices, mainly computerized repeat prescription and diagnostic data. The other 10% were identified only by psychiatric services. Over one third of the patients had no current contact with psychiatric services. Patients in contact with psychiatric services had been ill for a shorter time than those not in contact. More patients suffering from psychotic illnesses were in current contact than those with non-psychotic diagnoses. Over 90% of the patients had been seen by their general practitioners within 12 months, on average eight times. Most consultations were for minor physical disorders, repeat prescriptions and sickness certificates. Elements of the formal mental state examination were recorded in one third of cases and adjustments of psychotropic medication in one fifth. CONCLUSION: These findings suggest that patients in long-term contact with specialist services cannot be taken as representative of the whole population with long-term mental illness. General practitioners could use their frequent contacts with long-term mentally ill people to play a greater role in monitoring the mental state and drug treatment of this group.

Community Mental Health Services↗
PubMed1993

Distribution of mental health professionals working on site in English and Welsh general practices.

OBJECTIVE: To describe the nature and distribution of mental health professionals working on site in general practices. DESIGN: Postal questionnaire and telephone interview survey. SETTING: English and Welsh general practices. SUBJECTS: 1880 general practitioners, of whom 1542 (82%) responded. MAIN OUTCOME MEASURES: Prevalence, types, and distribution of mental health professionals working on site among general practices. Factors predicting the presence of mental health professionals on site. RESULTS: The number of practices reporting the presence on site of each type of professional were 528 for community psychiatric nurses; 266 for practice counsellors; 177 for clinical psychologists; 132 for psychiatrists; 96 for psychiatric social workers; and 45 for psychotherapists. Mental health professionals tended to cluster together in practices more often than expected by chance alone. Practice characteristics which independently predicted the presence of a mental health professional on site were having four or more partners; being a training practice; and running stress, bereavement, or other mental health clinics. The proportions of practices with mental health professionals on site varied significantly among health regions. There was no association between the presence of mental health professionals on site and the location of practices, the social class mix of patients, or the estimated percentage of elderly patients or patients of non-European origin. CONCLUSIONS: Mental health professionals tend to cluster together, with a preponderance in larger training practices. Specialist mental health care provision within general practices is unevenly distributed. Further research is needed to determine whether this uneven distribution reflects differences in need or inequalities in the provision of mental health services.

Community Mental Health Services↗