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Biomedical subjects

A Faulkner

Publications and source records attributed to A Faulkner.

At least 37 records · Page 2Linked to original sources
PubMed1998

Changes in the concentrations of glucagon-like peptide-1(7-36)amide and gastric inhibitory polypeptide during the lactation cycle in goats.

Plasma concentrations of glucagon-like peptide-1(7-36)amide (GLP) and gastric inhibitory polypeptide (GIP) were determined at fortnightly intervals for over a year throughout the pregnancy-lactation cycle of goats. Both GIP and GLP concentrations were elevated during lactation and fell rapidly when milk secretion was terminated. At the onset of lactation GLP concentrations rose rapidly whereas GIP concentrations showed a delayed response. GLP concentrations remained high throughout lactation but those of GIP declined linearly as milk yields fell. Serum insulin concentrations correlated positively with plasma glucose concentrations but not with either GIP or GLP concentrations. Negative correlations were found between serum insulin concentrations and milk yield and plasma non-esterified fatty acid concentrations. The results are consistent with plasma GIP and GLP concentrations being determined by other factors in addition to nutrient intake and absorption. Changes in GIP concentrations mirrored reported changes in the hypertrophy and atrophy of the intestine in ruminants while GLP concentrations may be more dependent on the neural and endocrine factors associated with lactation. The elevated concentrations of both peptides indicated a specific role in lactation independent of their normal anabolic and insulinotropic effects.

Animals↗
PubMed1998

Use of guidelines in primary care--practitioners' perspectives.

BACKGROUND AND OBJECTIVES: Concern about the inadequate take-up of guidelines in general practice has concentrated on problems arising from the process of their development and implementation. However, these perspectives fail to take account of the needs, attitudes and problems of GPs themselves. In this study we aimed to identify barriers to the use of guidelines and opportunities for tackling them, from the point of view of the GP, so that future guideline development and policy could be more sensitive to the needs of GPs in the environment in which they work. METHOD: Twenty in-depth semi-structured interviews were audiotaped with GPs from within the Avon Health Authority area, representing GPs with different backgrounds and working environments. The transcribed data collected were analysed using a grounded theory approach. RESULTS: Utilization of guideline information is complex. GPs' appraisals of the value of guidelines interact with prior knowledge and beliefs, practicalities of existing information storage and retrieval systems, and individual working practices. Conditions where guidelines are most likely to be referred to may be those either very rarely or very commonly presenting in general practice. Key issues for the uptake of guidelines in the consultation are: general preference for certain formats of presentation; reputability and ownership; use of guidelines in shared decision-making; scope for computer-based systems; and GPs' attitudes to time pressures on information-seeking in relation to tolerance of uncertainty. CONCLUSION: Local initiatives might usefully explore the possibilities of supporting development of guideline-retrieval systems customized for individual GPs or practices. Novel means of stimulating 'ownership' and demonstrating reputability should be sought. The analysis provides a framework for understanding the complexities of the processes of GPs' use of guidelines in practice which can be useful in explaining the results of trials of guideline effectiveness. Guideline implementation occurs in the context of conflicting pressures for clinical autonomy and professional standardization and quality improvement.

Attitude of Health Personnel↗
PubMed1998

Can we trust the quality of routine hospital outpatient information in the UK? Validating outpatient data from the patient administration system (PAS).

BACKGROUND: A validation study of routine hospital outpatient data was carried out as part of a broader project focusing on outpatient re-attendance. The aim was to compare two patient administration system (PAS) data items with the same information collected directly from hospital clinicians. METHODS: A total of 140 cases from four specialties at four National Health Service hospitals was randomly selected for comparison. The specific data items compared were the grade of doctor seen and the management decision taken following an outpatient appointment. The proportion of cases in which there was agreement was calculated, together with kappa values and relevant statistics indicating the accuracy of the PAS data when compared with information compiled immediately after the consultation by the relevant clinician. RESULTS: There was agreement between the clinician's data and the PAS data in 118/140 (84.3%) cases for grade of doctor seen and in 105/139 (76.7%) cases for the management decision. There was complete agreement for both items in 88/139 (62.6%) cases. Kappa values indicated good agreement between the two data sources. However, 'sensitivity' statistics suggested that the likely accuracy of each data item varied. CONCLUSION: Although there was good agreement within individual categories between the two sources, 37% of patient computerised records held at least one inconsistency in this small study focusing on only two data items. Further systematic evaluation is needed to test the extent to which other items are similarly discrepant.

Data Collection↗
PubMed1997

The concentrations of some gut polypeptides are elevated during lactation in ruminants.

Circulating concentrations of both glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1(7-36)amide (GLP-1) were determined in dry and lactating sheep. Both polypeptides were significantly higher in lactating animals compared with dry. The half-life of both in plasma was determined by intravenous injection of GIP or GLP-1 in both dry and lactating animals, but neither peptide showed a significantly different value during lactation. Thus, the increased circulating concentrations during lactation must result from increased secretion, probably resulting from the increased feed intake during lactation. Serum insulin concentrations were significantly lower during lactation, which poses the question of how lactating animals maintain lower circulating insulin levels in the presence of higher levels of insulinotropic agents.

Animals↗
PubMed1997

Diagnosis, management and screening of early localised prostate cancer.

The incidence of prostate cancer is rising worldwide, caused mainly by demographic factors, particularly the increasingly elderly population and, more importantly, the increasing number of cases identified following prostate specific antigen (PSA) testing. It is commonly quoted that many more men die with prostate cancer than of it. Autopsy/post-mortem studies show that while a very high proportion of elderly men have histological evidence of the disease, a much smaller proportion develop clinically apparent cancer. The natural history of prostate cancer is poorly understood, but progression appears to be related to stage and grade of tumour. Prostate cancer can be diagnosed by digital rectal examination (DRE), serum PSA test, and/or transrectal ultrasound (TRUS), with confirmation by biopsy. Each test identifies a proportion of cancers, with higher rates of detection when they are used in combination. The tests are also used to determine which tumours are localised within the prostate and are, thus, potentially treatable. Unfortunately, clinical staging is unreliable, with approximately one half of all tumours upstaged following surgery. Three major treatment options are available for localised prostate cancer: radical prostatectomy, radical radiotherapy and conservative management (involving monitoring and treatment of symptoms). Although radical treatment rates are rising, good quality evidence concerning their comparative effectiveness and cost-effectiveness is lacking. Observational studies of highly selected patient groups suggests that there may be a slightly lower mortality rate following radical treatments compared with conservative management, but there has been very little research into treatment complications and quality of life of men after any of the treatments. In the past, investigations of prostate cancer were reserved largely for patients exhibiting symptoms, but the introduction of the PSA test has opened up the possibility of screening healthy men for the disease. Observational studies suggest that DRE and PSA, combined with TRUS and biopsy, can identify localised prostate cancer in 3-5% of men, although the tests do result in a number of false positives and negatives. Major questions remain concerning the natural history of the disease, potential costs (financial, social and psychological) of a screening programme, and the effectiveness and cost-effectiveness of treatments for localised disease. The lack of good quality data and the strength of these concerns means that population screening for prostate cancer cannot be recommended.

Biopsy, Needle↗
PubMed1996

Patient reactions to met and unmet psychological need: a critical incident analysis.

Patients with cancer must deal with a variety of psychological and social difficulties, but the extent to which staff assist patients with these difficulties is not clear. Using the Critical Incident Technique (CIT), patients attending a Cancer Centre were asked to describe situations in which their emotional needs were, and were not, met by staff. Although most patients were able to describe a situation in which their needs were met by staff, 23% also described a situation in which this was not the case. These latter incidents were often related to anxiety, confusion and a wish to sever links with the hospital. Patients who reported that their needs were not met requested more staff time and further information about their diagnosis and treatment.

Adaptation, Psychological↗
PubMed1996

Helping cancer patients disclose their concerns.

Health professionals are reluctant to enquire actively about cancer patients' concerns and feelings. They fear that probing will damage patients psychologically and believe they have had insufficient training in the relevant interviewing skills. In considering how their interviewing skills might be improved, the key question is which interviewing behaviours promote patient disclosure and which inhibit it. To test our predictions about the utility of specific interviewing behaviours, we asked 206 health professionals, who were attending workshops on communication and counselling skills, to interview a simulated patient before and after the workshop to establish the patient's current problems. They were given 20 min to do this and the interviews were tape-recorded and transcribed to permit detailed assessment by trained raters using an utterance by utterance analysis. This permitted the form, function, content and emotional level of each utterance to be rated. Correlation coefficients were calculated between specific interviewing behaviours and patient disclosure of significant information. Significant information was defined as any information disclosed by patients about their perceptions of their illness or prognosis or any adverse physical, psychological or social sequelae of their cancer and treatment. Spearman correlation coefficients were calculated between specific interviewing behaviours and patient disclosure. The use of these behaviours by those 41 (20%) of interviewers who achieved most disclosure was compared with those 41 (20%) who obtained least disclosure. Patient disclosure of significant information was promoted by the use of open directive questions, focusing on and clarifying psychological aspects, empathic statements, summarising and making educated guesses. The use of leading questions, focusing on and clarifying physical aspects, moving into advice and reassurance mode inhibited patient disclosure. Inhibitory behaviours were used 2-3 times more frequently before training than facilitative ones. Training of health professionals involved in cancer care should, therefore, ensure they acquire these positive skills and relinquish the inhibitory behaviours.

Communication↗
PubMed1996

Care of oncology patients: caring for the carers.

The cost of caring for cancer patients is high emotionally for staff. As more emphasis is placed on skills training this cost may become higher as individuals are more able to identify their patients' concerns. It has been seen that health professionals can often identify with the cancer patient and feel somehow responsible for the current stage of medicine. This engenders helplessness in the face of treatments that may not work and the patient's uncertainty. It is suggested here that the organization should take some responsibility for caring for the carers by making time out a real possibility and by encouraging self care.

Caregivers↗
PubMed1996

Effects of somatostatin-28 on circulating concentrations of insulin and gut hormones in sheep.

The effects of intravenous somatostatin-28 (S28) infusion on glucose-stimulated and glucagon-like peptide-1(7-36)amide (GLP-1)-augmented insulin secretion were studied in sheep. S28 was infused via a jugular catheter for 15 min at a rate of 1.1 pmol/kg/min either alone or together with GLP-1 and/or glucose. S28 infusion did not significantly lower circulating basal insulin concentrations in fed sheep. Glucose-stimulated insulin secretion was significantly inhibited by S28 infusion, serum concentrations decreasing from about 200 to 150 pmol/l. GLP-1 significantly augmented glucose-stimulated insulin secretion, serum concentrations increasing from about 230 to 280 pmol/l. S28 completely counteracted this effect of GLP-1. S28 infusion also significantly decreased the circulating concentrations of glucose-dependent insulinotrophic polypeptide (GIP) and GLP-1 in fed sheep (from about 110 to 45 pmol/l for GIP and from about 25 to 15 pmol/l for GLP-1). The physiological implications of these observations are discussed with particular reference to the ruminant. It is concluded that S28 may have an important endocrine role in the control of insulin secretion and regulation of nutrient partitioning.

Animals↗
PubMed1995

Therapeutic relationships in complementary care.

This paper considers the role of the nurse in forming a therapeutic relationship with the patient in the context of complementary care. Therapeutic relationships are considered and the value of good interactive skills is demonstrated which allow assessment of need, and further show the value of helping a patient to talk through their concerns albeit the subject matter may be painful. The difference between traditional treatment, prescribed by the doctor, and complementary therapies, which are a matter of choice, has been considered. the need for the nurse to develop a knowledge base, non-judgemental attitudes and effective skills is seen to be crucial in offering the patient a relationship that is therapeutic and which allows the appropriate use of complementary therapies.

Health Knowledge, Attitudes, Practice↗