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C Paterson

Publications and source records attributed to C Paterson.

At least 19 recordsLinked to original sources
PubMed2000

In pursuit of patient-centred outcomes: a qualitative evaluation of the 'Measure Yourself Medical Outcome Profile'.

OBJECTIVES: To ascertain the ability of a patient-generated outcome measure, the 'Measure Yourself Medical Outcome Profile' (MYMOP), to reflect the outcomes of consultations which patients consider are most important, as derived from qualitative interviews. METHODS: A qualitative study using a constant comparative method to analyse semistructured interviews which were then compared with the results of MYMOP questionnaires. A variable-orientated analysis was used to develop themes and a case-orientated analysis was used to develop narrative summaries called vignettes from the interviews. The MYMOP questionnaire was completed by the interviewees (n = 20), a minimum to twice and a maximum of nine times over a four-month period. The scores were displayed on individual MYMOP charts. For each individual, the outcome as measured by MYMOP was compared with the outcome data from the qualitative interviews. The interviewees were attending a variety of complementary practitioners in primary care. RESULTS: The treatment effects which people described were encompassed by five themes: reduction in symptoms; reduction in disability; reduction in, or avoidance of, medication; gaining control and improving coping skills; and securing support and hope through the patient-practitioner relationship. The vignettes demonstrated how individuals identified and valued these various effects and weighed them up in evaluating the overall benefit of the treatment. Their MYMOP charts were able to measure some effects better than others. CONCLUSIONS: The treatment effects, as quantified using MYMOP, accorded with those described by most patients at interview, but some important limitations were identified with MYMOP, particularly an underplaying of the importance of medication avoidance or medication reduction in this patient group. This dimension is lacking in most outcome questionnaires and has been included in a new version of MYMOP. This study also showed that qualitative interview data can help in evaluating the ability of outcome questionnaires to measure the treatment effects that particular patient groups consider most important.

Adolescent↗
PubMed2000

Primary health care transformed: complementary and orthodox medicine complementing each other.

Charlotte Paterson is a general practitioner and researcher at Warwick House Medical Centre in Taunton, Somerset. This is a group practice where, since 1991, complementary practitioners have worked on a private sessional basis in the centre. This collaboration was the stimulus for an ongoing research programme into various aspects of complementary medicine and primary care, and the practice is now an NHS funded Research General Practice. Charlotte Paterson has taken a keen interest in different models of integrating complementary and orthodox medicine with the aim of making complementary medical provision equitable and accessible.

Complementary Therapies↗
PubMed2000

Organising primary health care for people with asthma: the patient's perspective.

BACKGROUND: The 1993 chronic disease management contract encourages United Kingdom general practices to implement a standardised package of care with an emphasis on regular visits to an asthma clinic. AIM: To explore the views of people with asthma about the organisation of asthma care in general practice. METHOD: Semi-structured interviews with 20 patients registered with one practice with a nurse-run asthma clinic. The sample was selected to provide people with a wide range of ages and disease severity, and included parents of children. RESULTS: The age range of the interviewees was five to 87 years (parents of children were interviewed) and half of the interviewees had attended the asthma clinic at some time. In describing how they managed their asthma, people identified their medical care alongside other important factors, such as avoiding smoking and pollution, and a decision to seek medical help was made in the context of all of life's other priorities. People expressed diverse views about the organisation of care, describing how their needs changed over time and how they balanced up several factors in deciding what was best for them. These factors were encompassed by four themes: the accessibility of care, severity of asthma and dealing with uncertainty, self-knowledge and self-management, and expert knowledge and therapeutic relationships. Interviewees were evenly split between wishing to be seen regularly in the clinic and wishing only to attend when needing help. CONCLUSION: Patients required asthma services that allow individual choice and flexibility, and eight service objectives were identified that would cover most people's needs.

Adolescent↗
PubMed1999

Prevalence and penetrance of BRCA1 and BRCA2 gene mutations in unselected Ashkenazi Jewish women with breast cancer.

BACKGROUND: Approximately 2.0%-2.5% of Ashkenazi Jewish women carry one of three founding mutations in the BRCA1 and BRCA2 genes, and each mutation is associated with a high lifetime risk of invasive breast cancer. We investigated the extent to which these three mutations contribute to breast cancer incidence in the Ashkenazi Jewish population. METHODS: We ascertained 457 Jewish women with prevalent cases of breast cancer who were unselected for age or family history of the disease; 412 of these women were tested for the three founder mutations (case patients). Control subjects consisted of 360 non-Jewish women with breast cancer (control patients) and 380 healthy Jewish women with no history of cancer (control subjects). RESULTS: Mutations were found in 48 (11.7%) of 412 Jewish case patients. Forty-six of 48 mutations occurred in women with early-onset breast cancer (<50 years) or a history of ovarian or early-onset breast cancer in a first-, second-, or third-degree relative. The estimated penetrance to age 70 years for breast cancer was 59.9% for the BRCA1 gene mutations and 28.3% for the BRCA2 gene mutation. Compared with Jewish control subjects, the relative risk (RR) of breast cancer for first-degree relatives of mutation carriers was 5.16 (95% confidence interval [CI] = 3.14-8. 48), but risk was also increased for relatives of noncarriers (RR = 1.66; 95% CI = 1.18-2.33). The RR of prostate cancer for first-degree relatives of Jewish case patients was 3.36 (95% CI = 1. 49-7.56). CONCLUSIONS: Approximately 12% of breast cancers in the Ashkenazi Jewish population are attributable to mutations in the BRCA1 or BRCA2 gene. Genetic testing may be useful when Jewish women with breast cancer are diagnosed before age 50 years or have a close relative with ovarian or early-onset breast cancer. An association between breast and prostate cancers was observed in our study population.

Aged↗
PubMed1999

Determination of corpora lutea numbers in Booroola--Texel ewes using transrectal ultrasound.

Ovulation rates in Booroola--Texel ewes are currently determined by laparoscopic examination of the ovaries during the luteal phase allowing for carrier status of the ewe to be diagnosed. However, this is an invasive procedure and the aim of this work was to determine whether or not transrectal ultrasound would be an acceptable and accurate alternative to laparoscopy for this purpose in ewes. Transrectal ultrasound was performed using a 5.0 MHz transducer in 18 ewes restrained in the standing position. They were then euthanized and laparoscopy was performed, following which the reproductive tracts were recovered. An additional 22 ewes were subjected to scanning in dorsal recumbency, using a 7.5 MHz transducer, at various stages of the luteal phase before being euthanized and the reproductive tracts recovered. The ovarian structures identified using each method were then compared. The results demonstrated that laparoscopy is an accurate method of determining ovulation rates in ewes. Transrectal ultrasound examination appeared to be an acceptable and non-invasive procedure. The use of a 7.5 MHz transducer with the ewes in dorsal recumbency produced the best results and clearest images of the ovaries, which allowed for the determination of the number of corpora lutea (CL) and the presence of other structures. Accuracy improved with experience in the technique, the stage of the luteal phase at which the examination was performed, the number of CL present in the ovary and the age of the ewe. Further work is needed to confirm this finding due to the small numbers of animals in the present study. This ultrasound technique, however, has the potential to provide an alternative to laparoscopy for the determination of numbers of CL in ewes.

Animals↗
PubMed1999

A pilot study to evaluate the effects of floatation spa treatment on patients with osteoarthritis.

OBJECTIVE: To conduct a preliminary investigation of the effects on floatation spa therapy on quality of life in patients with osteoarthritis to see if controlled trials are warranted. DESIGN: Uncontrolled clinical trial. SETTING: Private floatation spa therapy centre. PATIENTS: Fourteen patients with chronic osteoarthritis of the weight-bearing joints, of whom four dropped out. INTERVENTION: Six weekly sessions of floatation spa therapy. OUTCOME MEASURES: SF36, AIMS2 and MYMOP quality-of-life questionnaires. MAIN RESULTS: All patients improved. Differences between baseline and discharge scores showed statistically significant improvement for MYMOP, but not AIMS2 or SF-36. CONCLUSIONS: Controlled trials of floatation spa therapy for patients with osteoarthritis are warranted.

Aged↗
PubMed1997

Use of the polymerase chain reaction to sex the bovine fetus using cells recovered by ultrasound-guided fetal fluid aspiration.

The aim of this study was to carry out first trimester fetal sex diagnosis using the polymerase chain reaction (PCR) to amplify DNA from bovine fetal cells recovered by transvaginal ultrasound-guided uterine puncture and fetal fluid aspiration. For sex determination, a nested, allele-specific, PCR amplification of the bovine zfx and zfy gene fragments was utilised. The PCR assay was validated using fetal fluids recovered from uteri post mortem. Cells were harvested from the fetal fluids, genomic DNA extracted and the PCR assay applied. A technique which was developed for transvaginal ultrasound-guided follicle aspiration was modified to recover fetal fluid from live animals. Small volumes of fetal fluid (0.5-5 ml) were recovered between days 61-97 of gestation and the PCR assay applied. The gender determined by PCR of fetal fluid cells was in all cases confirmed by visual inspection (n = 15 abattoir specimens) or ultrasound scanning (n = 7 live animals). Fetal death, attributed to the introduction of intrauterine infection, occurred in 4/4 cows in the first series of aspirations but in only 1/3 heifers in the second series of aspirations.

Abattoirs↗
PubMed1997

Intracellular calcium mobilization following prostaglandin receptor activation in human ciliary muscle cells.

PURPOSE: To investigate the presence of specific prostaglandin receptors in primary cultures of human ciliary muscle cells by measuring agonist-stimulated intracellular calcium mobilization. METHODS: The ciliary muscle cells, cultured from postmortem human ciliary muscle explants, were first characterized by anti-desmin and anti-smooth muscle alpha-actin antibodies. Increase in intracellular calcium concentrations, in fura 2-AM loaded human ciliary muscle cells stimulated by prostaglandin receptor agonists, were determined with a digital fluorescence imaging system. RESULTS: The resting intracellular calcium concentration in the fura 2-AM loaded cells was 60.0 +/- 6.0 nM. The threshold concentration of PG receptor agonists needed to increase the concentration of intracellular calcium was 10(-8) M. The stimulation of these cells by PGF2 alpha, 17-phenyl trinor PGE2, and U46619, the FP, EP1, and TP receptor agonists, resulted in the dose-dependent increase of intracellular calcium. CONCLUSION: The results of the present study suggest that EP1, FP, and TP receptors are present in human ciliary muscle cells.

15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5↗
PubMed1997

Complementary practitioners as part of the primary health care team: consulting patterns, patient characteristics and patient outcomes.

BACKGROUND: Complementary medicine is increasingly popular with patients and with GPs, although it still remains mainly in the private sector. Few data are available from the private sector about patient-consulting patterns and outcome. OBJECTIVES: We aimed to describe detailed consulting patterns, help-seeking behaviour and outcome of care for patients attending a group of private complementary practitioners in a single general practice surgery. METHOD: Prospective data on consulting patterns were collected from all 147 new patients attending complementary practitioners over a 12-month period. For the first 30 weeks of this period, additional information on help-seeking behaviour and outcome, as measured by the SF-36 health survey and Measure Yourself Medical Outcome Profile (MYMOP), was collected by questionnaires from 46 out of the 68 new patients. The same information was collected from a systematic one-in-seven sample of GP patients. RESULTS: Patients seen by complementary practitioners did not vary significantly in sex and age from GP patients, except in the low numbers of children. Almost half the patients had been symptomatic for over a year and musculoskeletal disorders accounted for 66% of problems; but there was much variation between the therapies. The average number of visits per patient was three for osteopathy and homeopathy but eight for acupuncture and reflexology. The change in MYMOP scores after four weeks showed a statistically significant improvement in both complementary and GP patients, which was to similar degrees except that the mean change in well-being was significantly greater for complementary patients. CONCLUSION: Prospective data collection in single settings adds valuable information to a little-researched area. This study illustrates how individual each complementary therapy is in its patient characteristics, problem category and length of treatment. The particular improvement in well-being with complementary therapy requires confirmation in other studies.

Adolescent↗
PubMed1997

Use of contraception in women who present for termination of pregnancy in inner London.

OBJECTIVES: To describe the contraceptive usage of women undergoing termination of pregnancy in order to identify problems with contraception, and therefore suggest ways in which contraceptive services can be improved. DESIGN: Prospective study of attenders for NHS termination of pregnancy over a three month period. SETTING: Community based assessment clinics for NHS termination of pregnancy in inner London. SUBJECTS: Two hundred and sixty-nine women asking for assessment for NHS termination of pregnancy. MAIN OUTCOME MEASURES: Source of contraception, method used around time of conception, and problems experienced. RESULTS: Respondents tell into three groups: those using contraception around the time they became pregnant; those who had ceased to use contraception; and those that had never used contraception. The method of contraception used by the majority of the first group was the condom and the main source of the method was the chemist shop. The second group had most commonly used oral contraceptives in the past and had ceased use in many cases as a result of side effects. The majority of the third group did not speak English and had limited knowledge of methods of contraception. CONCLUSIONS: High usage of chemists means women avoid service providers who could offer help and advice. Women were prepared to put themselves at risk of unwanted pregnancy rather than return for further help and the lack of knowledge about emergency birth control was of some concern. The needs of black and ethnic minority women requires detailed work to improve access and acceptability of contraceptive services.

Adolescent↗
PubMed1996

Measuring outcomes in primary care: a patient generated measure, MYMOP, compared with the SF-36 health survey.

OBJECTIVE: To assess the sensitivity to within person change over time of an outcome measure for practitioners in primary care that is applicable to a wide range of illness. DESIGN: Comparison of a new patient generated instrument, the measure yourself medical outcome profile (MYMOP), with the SF-36 health profile and a five point change score; all scales were completed during the consultation with' practitioners and repeated after four weeks. 103 patients were followed up for 16 weeks and their results charted; seven practitioners were interviewed. SETTING: Established practice of the four NHS general practitioners and four of the private complementary practitioners working in one medical centre. SUBJECTS: Systematic sample of 218 patients from general practice and all 47 patients of complementary practitioners; patients had had symptoms for more than seven days. OUTCOME MEASURES: Standardised response mean and index of responsiveness; view of practitioners. RESULTS: The index of responsiveness, relating to the minimal clinically important difference, was high for MYMOP: 1.4 for the first symptom, 1.33 for activity, and 0.85 for the profile compared with < 0.45 for SF-36. MYMOP's validity was supported by significant correlation between the change score and the change in the MYMOP score and the ability of this instrument to detect more improvement in acute than in chronic conditions. Practitioners found that MYMOP was practical and applicable to all patients with symptoms and that its use increased their awareness of patients' priorities. CONCLUSION: MYMOP shows promise as an outcome measure for primary care and for complementary treatment. It is more sensitive to change than the SF-36 and has the added bonus of improving patient-practitioner communication.

Adolescent↗
PubMed1996

Identification of prostanoid receptors in rabbit non-pigmented ciliary epithelial cells.

Preliminary ligand binding studies demonstrated that the membrane preparations of the rabbit nonpigmented ciliary epithelial cell line have 3H-prostaglandin E2 binding sites. The binding sites were specific for 3H-prostaglandin E2 as demonstrated by competition with unlabeled prostaglandin E2. The IC50 of prostaglandin E2 for the inhibition of 3H-prostaglandin E2 binding was 435 nM. The stimulation of adenylyl cyclase and phospholipase C by prostanoid receptor agonists, in rabbit non-pigmented ciliary epithelial cells resulted in the formation of either cyclic AMP or inositol phosphates. Prostaglandin E2 and 16-16-dimethyl prostaglandin E2 (both are EP1, EP2, EP3 and EP4 receptor agonists). 11-deoxy prostaglandin E1 (EP2, EP3 and EP4 receptor agonist), butaprost (EP2 receptor agonist), and prostaglandin D2 (DP receptor agonist) stimulated the formation of cyclic AMP in a dose-dependent manner. Maximal stimulation occurred between 1.25 and 2.5 microM for prostaglandin E2 and 16,16-dimethyl prostaglandin E2 and between 10 and 20 microM for 11-deoxy prostaglandin E1 and prostaglandin D2. Prostaglandin E2 and 16,16-dimethyl prostaglandin E2 were more potent (EC50 of 0.25 microM and 0.42 microM respectively) than 11-deoxy prostaglandin E1, butaprost or prostaglandin D2. The formation of cyclic AMP by prostaglandin D2 was inhibited by BW868C, a highly selective DP receptor antagonist. 17-phenyl trinor prostaglandin E2, prostaglandin F2 alpha and U46619, the EP1, FP and TP receptor agonists, respectively stimulated phospholipase C (as measured by the formation of total inositol phosphates) in a dose-dependent manner. The agonists 11-deoxy prostaglandin E1 and butaprost coupled to adenylyl cyclase via guanine nucleotide binding protein, G8, did not increase the turnover of inositol phosphates. The results of the present study suggest that rabbit non-pigmented ciliary epithelial cells express EP1, EP2, DP, FP and TP receptors.

Adenylyl Cyclases↗