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PubMed2000

GP selection of postgraduate education courses has implications for colleagues: messages for course providers and for those writing practice professional development plans.

BACKGROUND: The Department of Health's review of continuing professional development in general practice advocates setting team and individual goals. AIM: To explore how general practitioners (GPs) share learning experiences with colleagues, focusing on how GPs choose courses as one factor influencing sharing. METHOD: Interviews were conducted with 21 GPs using grounded theory methodology. The responses were coded by six researchers from psychology, education, and general practice. RESULTS: Much sharing with colleagues took place, though not always immediately following a course. GP explanations revealed four reasons for course selection that influenced the degree of sharing: 1. Attendance to meet group needs encouraged rapid sharing and could involve course attendance with colleagues. 2. Attendance to enhance 'special interests' could either encourage or inhibit sharing. 3. Attendance in pursuit of 'personal interests' peripheral to general practice did not result in sharing within the primary care team. 4. Attendance to meet personal learning needs did not involve sharing when needs were not currently shared with colleagues. CONCLUSION: Course selection and subsequent sharing have implications for course providers and those writing personal and practice professional development plans.

Curriculum↗
PubMed2000

High-quality research and patient care: an overview of clinical trials.

BACKGROUND: One of the responsibilities of the dental profession is to protect and advance the well-being of the public through research of new pharmaceuticals and devices. The objective of this article is to present information about the scientific and regulatory process involved in the design and execution of randomized clinical trials. CONCLUSIONS: Dentists willing to serve as investigators in clinical trials--from Phase 1 to Phase 2 or Phase 3--need to be aware of the two main documents that contain the majority of guidelines and regulations governing clinical research: Title 21 of the U.S. Code of Federal Regulations and the guidelines for good clinical practice put forth by the International Conference on Harmonisation. CLINICAL IMPLICATIONS: Advancements in the frontiers of oral health science and the development of safe, innovative and effective treatment modalities are often the result of high-quality clinical research that is conducted by dental professionals. Knowledge of the research process, professionalism, scientific integrity and a detailed execution of the research plan are all required elements for a successful outcome.

American Dental Association↗
PubMed1996

Accurate diagnosis of carriers of deletions and duplications in Duchenne/Becker muscular dystrophy by fluorescent dosage analysis.

We have developed a semiautomated approach to amplify 25 exons of the dystrophin gene using two fluorescent multiplex PCR assays which detect over 98% of reported deletions and 90% of duplications causing Duchenne/Becker muscular dystrophy. The 5' multiplex detects 11 exons from the proximal deletion hotspot of the gene while the 3' multiplex detects 14 exons from the central deletion hotspot. The PCR products are accurately sized and quantified by a fluorescent DNA sequencer after only 18 cycles of amplification. The amount of product amplified from each exon in a multiplex is divided by that from each of the other exons, and this ratio is compared with those from control samples to obtain a series of dosage quotients (DQ), from which the copy number of each exon is determined. No overlap was observed between the DQ values obtained from single and double copy loci. The assays can be used to screen both affected males and at risk female relatives for a mutation. The method has been evaluated as a female carrier test by conducting a blind trial on 150 coded samples. Sixty-three deletion carriers, two duplication carriers, and 84 normal female controls were all correctly identified, showing that carrier diagnosis is possible even in families where the nature of the mutation is unknown. Additionally the analysis showed a non-pathogenic duplication involving the muscle specific promoter and exon 1. Together these two multiplex assays detect over 70% of all mutations in the dystrophin gene, greatly simplifying and partly automating molecular diagnosis in Duchenne and Becker muscular dystrophy.

Automation↗
PubMed2000

An exploratory qualitative study examining the social and psychological processes involved in regular dental attendance.

OBJECTIVE: This study aimed to provide a description of the psychosocial process involved in regular dental attendance. METHODS: The study design was a qualitative cross-sectional study using unstructured and semistructured interviews and observations of regular dental visits. The study participants included 12 men and 18 women attending general dental practices and six men and four women attending an emergency dental service. The data were systematically recorded and subjected to line-by-line grounded theory coding around the main concerns of those attending the dentist. RESULTS: The main concern of those attending for a regular dental visit was checking their oral health. The six-month recall was conceptualized as a checking cycle in six phases: recalling, responding, inducing (i), waiting, inducing (ii), and telling. The possible outcomes of the cycle were maintaining oral health, sustaining oral health, and a further checking cycle. Variations in checking cycles resulted from reordering and normalizing pressures within participants' lifestyles. CONCLUSIONS: The findings of this study suggest that people's patterns of dental attendance are similar to those of other chronic illnesses. An understanding of the dynamic psychosocial processes involved in frequent dental attendance may be achieved when further research into this phenomenon is conducted.

Appointments and Schedules↗
PubMed2003

Family secrecy: a comparative study of juvenile sex offenders and youth with conduct disorders.

The reported research was designed to compare adjudicated male juvenile sexual offenders and youth with conduct disorders on five aspects of family secrecy and deception. Twenty-nine male juvenile sex offenders and 32 comparison youth from three child welfare agencies in New York State participated in the study. Research assistants, blind to the hypotheses of the study and status of the youth, coded agency records for five variables identified a priori as a basis of comparison. Analyses revealed that the two groups were different on three of the five and on the total number of items scored. Families of juvenile sex offenders told more lies, had more family myths, and were more likely to be involved in taboo behavior. Logistic regression revealed that this factor of family deception significantly increased the odds of sexual offending over and above other measures of family pathology. These data support the hypotheses of the study and have implications for both clinical practice and future research in this area.

Adolescent↗
PubMed1995

Electrodographic analysis and field evaluation of the Speak coding strategy.

The Speak speech-coding strategy for the Nucleus Minisystem-22 cochlear implant continuously analyzes the speech signal using 20 digitally programmable band-pass filters and presents up to 10 spectral maxima to the implanted electrodes. To analyze the performance of this system for a variety of speech sounds in quiet and noise, the stimulation patterns of the implanted electrode array were reconstructed from the transmitted radio frequency signals by software as electrodograms and compared to electrodograms generated by other speech-coding strategies, as well as to the spectrograms of the input signals. The performance with the Speak strategy relative to that with the Multipeak (Mpeak) speech-processing strategy was also evaluated in a field trial study with 20 native German-speaking cochlear implant users from four European implant centers, involving a variety of auditory perceptual tasks in an ABAB paradigm over a 12-week period. Vowel, consonant, and monosyllable word tests, as well as sentence tests in quiet and noise, were conducted. Significant differences in group mean scores for most speech recognition subtests were obtained for the Speak versus the Mpeak strategy, with the largest overall improvements observed for the sentence tests in noisy conditions.

Adult↗
PubMed2005

Analysis of factors contributing to 674 agricultural driveline-related injuries and fatalities documented between 1970 to 2003.

Unguarded agricultural power take-off (PTO) drivelines and related components, including secondary drivelines powered by the PTO, have been historically recognized as serious farm-related hazards that can cause severe, permanently disabling injuries and death when entanglement occurs. The lack of longitudinal and causative data on these incidents has been a barrier for developing relevant and effective intervention strategies. A study was conducted at Purdue University to design, develop, and test a system to document, code, store, and analyze a large amount of agriculture driveline-related injury and fatality data to allow for identification of causative factors and trends that could be used in developing engineering, educational, and regulatory solutions. This was accomplished by first developing a standardized injury reporting form and coding system and then developing an electronic database, using Microsoft(R) Access 2002,(R) which could be used to document, store, query, and analyze agricultural driveline-related incident data. Incidents resulting in injury or fatality identified between 1970 and 2003 were documented and the available data coded and entered into the database using a systematic approach. A pilot-test of the usability of the database was conducted on data collected from 92 incidents involving children and adolescents. Using the validated data management system, an analysis was conducted on data collected from 674 cases entered into the database. Findings from the analysis of the data included the following: the frequency of documented agricultural driveline-related incidents increased from the 1970s to the 1980s, but then decreased through the 1990s and into the 2000s; the 11 to 15-year-old age group had the highest frequency of cases; incidents occurred more often in the fall season; and augers, elevators, or conveyors were the type of implements most frequently involved. Recommendations were made to reduce the risk of agriculture driveline injuries and for future research.

Accidents, Occupational↗
PubMed1991

Judging social issues: difficulties, inconsistencies, and consistencies.

The three studies reported in this Monograph examine high school and college students' reasoning about the issues of abortion, homosexuality, pornography, and incest. The studies stemmed from previous research on reasoning in the "prototypical" moral, social conventional, and personal domains. We postulated that abortion, homosexuality, pornography, and incest are nonprototypical issues. We expected that reasoning about nonprototypical and prototypical issues would differ and that reasoning about nonprototypical issues would be inconsistent and involve ambiguities in informational assumptions. Two groups were preselected in Study 1, those who negatively and those who positively evaluated the nonprototypical issues. Assessments were made of criterion judgments (evaluations, rule contingency, and generalizability) and justifications regarding moral, personal, and nonprototypical issues. The groups differed in judgments about the nonprototypical issues but not the moral issues. Both groups gave noncontigent and generalized judgments about moral issues, with justifications of justice and rights. Subjects who evaluated nonprototypical acts negatively used varied and often inconsistent configurations of criterion judgments. Responses coded for general reasoning types often entailed juxtapositions of prescriptive judgments and assertions of personal choice. Subjects who evaluated nonprototypical acts positively judged that they should be legal and nongeneralized and gave justifications based on personal choice. Using similar procedures, Study 2 was conducted with practicing Catholics attending parochial high schools. The findings paralleled those of Study 1, including a split among subjects in their evaluations of the nonprototypical issues. The results suggested a bidirectional relation between individual judgments and group positions. The findings of Studies 1 and 2 suggested that variations in evaluations and judgments about the nonprototypical issues were associated with variations in ambiguously held informational assumptions. Study 3 examined the role of such informational assumptions. It was found that assumptions associated with judgments about abortion and homosexuality were ambiguous and inconsistently applied. Thus, we propose that ambiguity around assumptions is a central component of the nonprototypicality of these issues.

Abortion, Legal↗
PubMed1992

Professional ethics as perceived by American nursing undergraduates.

The purpose of the study was to explore the perceptions of American nursing undergraduates about professional ethics. The method was qualitative; specifically, a grounded theory approach was used. The sample comprised 23 senior baccalaureate nursing students, from a possible population of 120, who were in their final clinical rotation prior to graduation. Informants were volunteers who gave informed consent having been briefed on the purposes of the study and how their confidentiality would be protected. Data were collected through audio-taped interviews and clinical logs. Analysis was conducted through the constant comparative method. Findings revealed two concepts central to their view of good nursing. These were: (a) respect, and (b) caring. Respect was described as respect for patients and families, respect for self, colleagues and the profession. Caring was associated with showing 'concern and love', providing psychological support, getting involved, being 'cheerful and friendly' and 'taking the time' to do a good job. They did not evidence an ambiguous professional role. They espoused values consistent with the professional code of ethics. They perceived that respect for others was basic to good nursing. They believed that good nurses cared about their patients and how nursing was done. They appeared to link professionalism with good nursing.

Adult↗
PubMed2006

A novel mutation in the SH3BP2 gene causes cherubism: case report.

BACKGROUND: Cherubism is a rare hereditary multi-cystic disease of the jaws, characterized by its typical appearance in early childhood, and stabilization and remission after puberty. It is genetically transmitted in an autosomal dominant fashion and the gene coding for SH3-binding protein 2 (SH3BP2) may be involved. CASE PRESENTATION: We investigated a family consisting of 21 members with 3 female affected individuals with cherubism from Northern China. Of these 21 family members, 17 were recruited for the genetic analysis. We conducted the direct sequence analysis of the SH3BP2 gene among these 17 family members. A disease-causing mutation was identified in exon 9 of the gene. It was an A1517G base change, which leads to a D419G amino acid substitution. CONCLUSION: To our knowledge, the A1517G mutation has not been reported previously in cherubism. This finding is novel.

Adaptor Proteins, Signal Transducing↗
PubMed1990

Methodology of ECG interpretation in the Dalhousie program; NOVACODE ECG classification procedures for clinical trials and population health surveys.

The Dalhousie ECG Program was designed specifically for the needs of epidemiologic studies, health surveys, and clinical trials. The program logic is dynamic in that it can accommodate any combination of ECG leads, record length and sampling rate. The NOVACODE module of the program classifies ECGs according to the Minnesota Code, supplemented with new sets of logic criteria for conduction defects, acute myocardial infarction, and serial ECG changes. Improved statistical models are incorporated for enhanced detection of myocardial infarction using the Cardiac Infarction Injury Score, and for quantification of left ventricular mass estimation. It is anticipated that these program improvements will enhance its utility particularly in monitoring progression and regression of cardiac involvement in hypertensive and ischemic heart disease, and in the assessment of the effectiveness of intervention on cardiovascular disease risk factors.

Adolescent↗
PubMed1995

Characterization of DNASE I hypersensitive sites in the 120kb 5' to the CFTR gene.

The chromatin structure of 120kb of genomic DNA 5' to the CFTR gene has been analysed in a number of CFTR expressing and non-expressing cell types, including primary genital duct epithelial cells. Novel DNAse I hypersensitive sites have been observed at -79.5kb and -20.5kb 5' to the ATG translation start codon of the CFTR coding sequence. Neither of these sites appears to show strong correlation with CFTR expression in the cell types investigated, hence they are unlikely to reflect the sites of binding of the major CFTR tissue specific regulator(s). However, they may still play an important part in the complex series of events involved in the regulation of CFTR transcription.

Base Sequence↗
PubMed2002

A double-blind, placebo-controlled, randomized trial of Ginkgo biloba extract EGb 761 in a sample of cognitively intact older adults: neuropsychological findings.

There appears to be an absence of large-scaled clinical trials that have examined the efficacy of Ginkgo biloba extract on the neuropsychological functioning of cognitively intact older adults. The importance of such clinical research appears paramount in light of the plethora of products containing Ginkgo biloba that are currently being widely marketed to predominantly cognitively intact adults with claims of enhanced cognitive performances. The purpose of this research was to conduct the first known, large-scaled clinical trial of the efficacy of Ginkgo biloba extract (EGb 761) on the neuropsychological functioning of cognitively intact older adults. Two hundred and sixty-two community-dwelling volunteers (both male and female) 60 years of age and older, who reported no history of dementia or significant neurocognitive impairments and obtained Mini-Mental State Examination total scores of at least 26, were examined via a 6-week, randomized, double-blind, fixed-dose, placebo-controlled, parallel-group, clinical trial. Participants were randomly assigned to receive either Ginkgo biloba extract EGb 761(n = 131; 180 mg/day) or placebo (n = 131) for 6 weeks. Efficacy measures consisted of participants' raw change in performance scores from pretreatment baseline to those obtained just prior to termination of treatment on the following standardized neuropsychological measures: Selective Reminding Test (SRT), Wechsler Adult Intelligence Scale-III Block Design (WAIS-III BD) and Digit Symbol-Coding (WAIS-III DS) subtests, and the Wechsler Memory Scale-III Faces I (WMS-III FI) and Faces II (WMS-III FII) subtests. A subjective Follow-up Self-report Questionnaire was also administered to participants just prior to termination of the treatment phase. Analyses of covariance indicated that cognitively intact participants who received 180 mg of EGb 761 daily for 6 weeks exhibited significantly more improvement on SRT tasks involving delayed (30 min) free recall (p < 0.04) and recognition (p < 0.01) of noncontextual, auditory-verbal material, compared with the placebo controls. The EGb 761 group also demonstrated significantly greater improvement on the WMS-III FII subtest assessing delayed (30 min) recognition (p < 0.025) of visual material (i.e. human faces), compared with the placebo group. However, based on the significant difference (p < 0.03) found between the two groups' pretreatment baseline scores on the WMS-III FII, this result should be interpreted with caution. An examination of the participants' subjective ratings of their overall abilities to remember by treatment end on the Follow-up Self-report Questionnaire also revealed that significantly more (p = 0.05) older adults in the EGb 761 group rated their overall abilities to remember by treatment end as 'improved' compared with the placebo controls. Overall, the results from both objective, standardized, neuropsychological tests and a subjective, follow-up self-report questionnaire provided complementary evidence of the potential efficacy of Ginkgo biloba EGb 761 in enhancing certain neuropsychological/memory processes of cognitively intact older adults, 60 years of age and over.

Aged↗
PubMed2003

Patients' decision-making for migraine and chronic daily headache management. A qualitative study.

The objective of this study was to gain insight into the patients' decision-making for migraine and chronic daily headache management. Patients were recruited by theoretical sampling in Surrey (UK). Semi-structured and tape-recorded interviews (n = 13) were conducted, transcribed verbatim, coded and analysed according to the grounded theory methodology. Thirteen patients (8 migraine and 5 chronic daily headache) described their management. All patients employed multiple behaviours to manage their headaches. From the patients' descriptions emerged their decision-making. Based on experience, perceptions and new information, the decision-making process involved four stages: headache severity, evaluation, decision making and behaviours. Although the participants were passive with regards to certain management strategies, overall they were actively involved in treating and preventing their headaches. Furthermore, they were active decision-makers in choosing appropriate management. Migraine and chronic daily headache patients are actively involved in managing their headaches. They are key decision-makers and should not be overlooked as a resource for effective management.

Adult↗
PubMed2000

A competency model for general practice: implications for selection, training, and development.

BACKGROUND: The role of the general practitioner (GP) has changed significantly over the past decade. This problem is compounded by growing concern over postgraduate attrition rates from medicine, with current estimates as high as 19%. AIM: To define a comprehensive model of the competencies required for the job role of GP. METHOD: Three independent studies were conducted to define GP competencies including (1) critical incidents focus groups with GPs, (2) behavioural coding of GP-patient consultations, and (3) critical incidents interviews with patients. Study 1 was conducted with GPs (n = 35) from the Trent region. Study 2 involved observation of GP-patient consultations (n = 33 consultations), and Study 3 was conducted with patients (n = 21), all from a Midlands-based medical practice. RESULTS: The data collected from the three studies provided strong evidence for a competency model comprising 11 categories with a summary of the associated behavioural descriptions. Example competencies included empathy and sensitivity, communication skills, clinical knowledge and expertise, conceptual thinking, and coping with pressure. CONCLUSIONS: Triangulation of results was achieved from three independent studies. The competencies derived imply that a greater account of personal attributes needs to be considered in recruitment and training, rather than focusing on academic and clinical competency alone. The model could be employed for future research in design of selection techniques for the role of GP.

Clinical Competence↗
PubMed1996

Validity review of performance measures.

A structured process for evaluating the validity of performance measures is essential if the rates generated by these measures are to be relied upon for large-scale programmes to improve clinical care. In this evaluation process a panel of objective clinicians who were not involved in developing the performance measures examines the criteria, coding instructions, and coding form. The panel's job is to determine the degree to which a sample of patient records containing treatment elements that have been flagged for nonconformance to certain criteria are truly nonconformant. Modification of the performance measure according to the recommendations of the panel provides an important means of reducing measurement error by eliminating obvious sources of false positive findings. This article describes the procedures followed and the materials used to validate the performance measures developed for the project to Develop and Evaluate Methods for Promoting Ambulatory Care Quality (DEMPAQ), a research project contracted by the Health Care Financing Administration of the United States government [1-3]. DEMPAQ is described in Fig. 1. In the DEMPAQ project, record review is conducted by entering data directly from patient ambulatory records into a computer system. Instructions for abstracting the data are displayed on the computer monitor.

Alabama↗
PubMed2000

Verbal coding in olfactory versus nonolfactory cognition.

Two paired-associate memory experiments were conducted to investigate verbal coding in olfactory versus nonolfactory cognition. Experiment 1 examined the effects of switching/not switching odors and visual items to words between encoding and test sessions. Experiment 2 examined switching/not switching perceptual odors and verbal-imagine versions of odors with each other. Experiment 1 showed that memory was impaired for odors but not visual cues when they were switched to their verbal form at test. Experiment 2 revealed that memory was impaired for both odors and verbal-imagine cues when they were switched in format at test and that odor sensory imagery was not accessed by the instruction to imagine a smell. Together, these findings suggest that olfaction is distinguished from other sensory systems by the degree of verbal coding involved in associated cognitive processing.

Adult↗