Search PubMed⌕ Search

Biomedical subjects

A Miles

Publications and source records attributed to A Miles.

At least 55 records · Page 3Linked to original sources
PubMed1996

Cell adhesion mechanisms: modeling using derivatized beads and sea urchin cell systems.

Agarose beads derivatized with amino acids, peptides, carbohydrates and lectins were used to systematically determine what types of molecules, isolated from all others, can make adhesive bonds strong enough to hold cell-like beads together. The results indicated that strong adhesion occurred when at least one of the two members of certain bead pairs was derivatized with molecules that were dimers or trimers but not monomers. Also, beads derivatized with phosphorylated amino acids, but not their non-phosphorylated counterparts, adhered to beads derivatized with positively charged peptides. Adhesion was sensitive to ionic strength and pH of the medium. It was proposed that adhesion occurred between the phosphate groups of the phosphoamino acids and amino and guanidinium groups of the peptides. Cooperative bonding can explain the stability of the adhesion observed in this system. Information gained from the bead modeling work was used to design experiments to examine the role of phosphorylated molecules in modulating adhesion in sea urchin systems. Phosphoamino acids inhibited sperm-egg interaction, but not reaggregation of blastula cells. Inhibitors of alkaline phosphatase, however, did inhibit reaggregation. The results suggest that cell surface phosphorylated molecules may modulate cellular adhesiveness, in some systems promoting, while in others inhibiting adhesion.

Amino Acids↗
PubMed1996

'My pain is God's will'.

Two colleagues, a clinical nurse specialist and a chaplain, explain how they've dealt with patients who feel obligated to suffer for religious reasons.

Adult↗
PubMed1996

Central dimensions of clinical practice evaluation: efficiency, appropriateness and effectiveness--I.

Successful audit of clinical practice focuses upon the systematic investigation of key aspects of the everyday work of busy clinicians. We contend that the nature and quality of local clinical practice can be characterized by critical examinations of the effectiveness and appropriateness of practice and the efficiency with which effective, appropriate clinical care is delivered to patients. When such a baseline has been established, it becomes possible to compare and contrast characterized local practice with so-called 'evidence-based' practice and agree changes aimed at narrowing the discrepancy between the two. The nature of such changes can be described and their implementation into practice studied, with subsequent quantitative measurement and qualitative description of the resulting benefits to patients. A proper understanding of the concepts of efficiency, appropriateness and effectiveness in clinical care is clearly fundamental to the successful design and applications of methodologies aimed at securing measurable improvements in the quality of patient care. In this first of two articles we examine the concepts of efficiency and appropriateness in clinical practice, with particular emphasis on cost-effectiveness and utilization review. The clinical effectiveness of health care intervention is treated in detail within the second paper, to be published within Volume 2 Number 2 of the Journal of Evaluation in Clinical Practice (Miles et al. 1996f).

Clinical Medicine↗
PubMed1996

Clinical audit in the National Health Service: fact or fiction?

It is increasingly recognized that the repeated rhetorical emphasis from 1989 to date on achieving measurable benefits to patients from audit, in the face of inattention to the development of methodologies with which to realize such benefits in operational practice, has represented a serious deficiency in strategic planning and direction and a consequent failure to establish functional clinical audit within the NHS. A grand revision of strategy is therefore necessary, and this should begin with the development of a research-based method of audit, the training of clinicians and audit support staff in its use and a subsequent trial of its effectiveness prior to its implementation within the NHS. Only then will measurable improvements become possible, value for money be assured and clinicians' attitudes to audit change.

Attitude of Health Personnel↗
PubMed1996

The Total Health Care Audit System: a systematic methodology for clinical practice evaluation and development in NHS provider organizations.

Writing in Medical Education in 1982, Fowkes (1982) noted the lack of general agreement within the medical profession on methods of audit, a deficiency previously articulated by Shaw (1980) and later emphasized by McIntyre (1985). More recently, a study by Black & Thompson (1993) of consultant and junior medical staff in four London district general hospitals revealed that 'many doctors did not understand how to undertake audit', and major research by both Hopkins (1993, 1994) and Buttery et al. (1994) described a multiplicity of methodological deficiencies in the general approaches to audit adopted by clinicians since the promulgation of the White Paper definition in 1989. Soundness of methodological approach is fundamental to securing the success of clinical audit within Provider organizations and is thus central to the generation of measurable improvements in the quality of clinical care being delivered to patients. It is therefore disturbing that methodological deficiencies may still be observed in general approaches to audit (Buttery et al. 1994), with no author yet recommending a formal system for critical inquiry into clinical practice. It was the recognition of the unsatisfactory nature of this situation which led us to develop a system aimed at assessing, in a critical fashion, the quality of the totality of care dispensed within NHS provider organizations. The system is presented here for the first time.

Algorithms↗
PubMed1996

Central dimensions of clinical practice evaluation: efficiency, appropriateness and effectiveness--II.

That a treatment selected for a given condition works, or that it works better than alternative treatments, or that it was selected because it works as well as but is cheaper than alternative treatments, should be of pivotal concern to clinicians and is of central concern to patients and to health care managers. Attempts to address these concerns have resulted in what is now widely termed the 'effectiveness movement'. The protagonists of the movement have been concerned to create a culture of evaluation and inquiry within which the formulation of evidence-based clinical guidelines and their introduction into routine practice have played a prominent part. The need to ensure cost effectiveness of clinical intervention has been at least as emphasized as the need to ensure the clinical effectiveness of health care interventions. Although cost-effectiveness analyses are now an indispensable feature of practice guideline formulation and treatment evaluation, few studies have examined any deterioration in patient outcome associated with successful cost containment. An adequate understanding of the concept of clinical effectiveness and the associated aims of the 'effectiveness movement' is central to an understanding of the future nature and extent of health service provision, not simply in the UK but also internationally. Having examined the concepts of efficiency and appropriateness previously (O'Neill, Miles & Polychronis 1996, Journal of Evaluation in Clinical Practice 2, 13-27) we move in this second of two articles to a detailed explanation of the concept of effectiveness, and to an examination of the derivation and use of clinical practice guideline, concluding with a consideration of the role of practice guidelines in ensuring the cost effectiveness of health care intervention. The reservation is expressed that a 'guidelines culture', when established, will be manipulated by health care commissioners for largely political purposes, creating a systematic bias in the purchasing process that will actively disadvantage a range of patient groups.

Cost-Benefit Analysis↗
PubMed1996

Use of radionuclide imaging to determine gastric emptying of carbohydrate solutions during exercise.

OBJECTIVE: To investigate the repeatability of continual assessment of the gastric emptying rates of carbohydrate solutions in exercising subjects using 99mtechnetium labelling. METHODS: Gastric emptying of a 5% glucose solution and an iso-osmotic maltodextrin solution was measured using 3 MBq of 99mtechnetium labelled diethylene triamine penta-acetic acid (DTPA) and continuous gamma camera imaging in five male subjects. The subjects performed four 1 h trials at 70% VO2 peak on a cycle ergometer. After 15 min, 200 ml of a radiolabelled solution of glucose or maltodextrin were ingested in a blind crossover protocol. The two solutions were each ingested on separate occasions (trial 1 and trial 2) to establish repeatability. RESULTS: Statistical analysis showed no differences between trial 1 and trial 2 for both solutions. There were no significant differences for the emptying rates between the two test solutions. CONCLUSIONS: Posterior imaging using a computer linked gamma camera following the ingestion of 99mtechnetium labelled DTPA mixed with carbohydrate solutions provides a repeatable method of assessing gastric emptying characteristics in exercising subjects. This technique showed no significant differences between the emptying rates of a single dose of iso-osmotic glucose or maltodextrin solution.

Adult↗
PubMed1995

A preliminary study of factors that influence children's sense of competence to manage their asthma.

This study identifies several factors that appear to influence children's sense of competence to manage their asthma. The study examined a consecutive series of 62 children and adolescents who had been admitted to hospital for management of their asthma. Self-reports rating their sense of competence to manage their asthma were obtained from all the children. In addition, reports were obtained of the children's motivation to achieve healthy functioning, their sense of control over their health, and parental knowledge of childhood asthma management. Results from the study suggest that older children, children who are more intrinsically motivated to achieve healthy functioning, and children with parents who are knowledgeable about asthma management feel more competent to manage their asthma. It is suggested that the effectiveness of asthma self-management programs for children may be improved if there is a better understanding of the psychological factors that influence children's sense of competence to manage their asthma.

Adolescent↗
PubMed1994

Commentary. Mid-life confessions.

Although he recalls times in his work as a hospital chaplain when he cared for people superficially, the author notes that patients themselves ministered to him, teaching him more compassionate ways to serve.

Adult↗