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Biomedical subjects

C Taylor

Publications and source records attributed to C Taylor.

At least 163 records · Page 9Linked to original sources
PubMed1997

The effect of cash and other financial inducements on the response rate of general practitioners in a national postal study.

BACKGROUND: Low response rates are acknowledged as a potential source of bias in survey results. Response rates are a particular problem in surveys of GPs. Thus, the methods used to encourage response to mailed surveys and the influence of inducements in maximizing response rates are fundamental issues to be examined when addressing the problem of response bias. AIM: To increase the overall response rate to a national study of GPs and to explore the effects of financial and non-financial inducements on response rates. METHODS: Two mailing waves of a postal questionnaire to a 20% random sample of all GPs in England and Wales had achieved a 33% response rate. For the third mailing wave, the non-responding GPs were then divided into a control group, a group who were offered a donation to charity to complete the questionnaire and a group who were offered cash. The charity and cash groups were further subdivided into 5 pounds and 10 pounds groups to assess the effect of the size of the inducement offered. For the control group, a fourth wave was sent the offer of a 5 pounds or 10 pounds incentive. RESULTS: Response was positively affected by the offer of an inducement. Cash, however, had a more substantial effect than the offer of a donation to charity. Older GPs were less likely to participate overall, whereas male GPs were more likely to respond to a cash inducement. Doctors who had seen more patients were less likely to reply earlier and were more likely to respond to the offer of cash. CONCLUSIONS: Primary care is going through many changes, some of which have increased the workload of the GP. It may now be that, to achieve the response rates needed to validate policy-related research, the offer of inducements will become a necessary part of the research process.

Adult↗
PubMed1997

Surveying general practitioners: does a low response rate matter?

BACKGROUND: Primary care has long been of interest to policy research. Recently, there is evidence to suggest that it is becoming more difficult to encourage GPs (general practitioners) to participate in surveys. As low response rates can introduce bias into survey results, it is important to study the effects of non-response. AIM: To assess the validity of a response rate of 44% obtained in a national postal study of GPs surveyed about their work with alcohol-misusing patients by assessing the extent of any non-response bias. METHOD: A telephone survey of 148 GPs who had not responded to repeated mailings of a postal questionnaire was undertaken. In addition to personal and practice structure characteristics, the GPs were asked three questions taken from the original questionnaire about their work with alcohol-misusing patients. RESULTS: Of the 148 GPs telephoned, 64 responded to the telephone questionnaire in full; all had previously failed to respond to the postal questionnaire. Younger GPs were more likely to respond to both the national postal and telephone surveys, but more so to the latter. Telephone responders were more likely to be GPs in a single-handed practice. The work of GPs with alcohol-misusing patients highlighted differences between the two response groups. Male telephone responders were found to be identifying a significantly higher average of alcohol misusers than male postal responders. Telephone responders were more likely to feel trained in treating alcohol misuse and to feel better supported to deal with this patient group. CONCLUSION: Some significant differences were identified, indicating the presence of non-response bias. A low response rate need not affect the validity of the data collected, but it is still necessary to test for non-response effects and make corrections to the original data in order to maximize validity.

Adult↗
PubMed1997

A guide to managing workforce transitions.

Recognizing leadership styles and team-building interventions that work help nurse managers change skills and strategies to meet the demands of a workforce reorganization. Three key strategies are identified: emotional management, professional empowerment and empowerment by values. All members involved in the reorganization were given room to grow, to make mistakes and to learn from them.

Adaptation, Psychological↗
PubMed1997

The general practitioner, the drug misuser, and the alcohol misuser: major differences in general practitioner activity, therapeutic commitment, and 'shared care' proposals.

BACKGROUND: The primary care setting has been regarded in government policy and the scientific literature as an ideal setting for the work needed to meet the Health of the Nation drug and alcohol targets. Although studies have pointed to the negative attitudes held by general practitioners (GPs) towards alcohol- and drug-misusing patients, there has been no direct comparison of the work and attitudes of the GP towards these patients. AIM: To compare the work and attitudes of GPs towards alcohol- and drug-misusing patients. METHOD: All GPs in an outer London area (157 doctors) were surveyed, using an eight-page postal questionnaire, collecting clinical and attitudinal data alongside demographics and practice information. A response rate of 52% was achieved. RESULTS: General practitioners reported working with only 3.5 patients drinking above recommended guidelines in the previous four working weeks, and even fewer drug-using patients (0.75). While they viewed the alcohol-misusing patients negatively, the drug misuser elicited substantially more negative attitudes. The primary care setting was seen as appropriate to work with the alcohol-misusing patient but not with drug users. Training and support from local services would encourage substantially more GPs to work with alcohol misusers but not with drug misusers. CONCLUSIONS: Our findings indicate that there are some cautious grounds for optimism that GPs are willing to work with alcohol misusers; however, with regard to drug misusers, we find a GP workforce that is only minimally involved with this group and would not be greatly encouraged by the provision of additional training, support, or incentives. The Health of the Nation targets are not being met, and GPs are not detecting adequate numbers of the patients at whom these targets are aimed. Emphasis has been placed on the role of primary care, but the real achievements that can be made require detection of the less severe drinkers and injecting drug misusers.

Adolescent↗
PubMed1997

HIV prevention and drug treatment services for drug misusers: a national study of community pharmacists' attitudes and their involvement in service specific training.

AIMS: To investigate the attitudes of community pharmacists towards HIV prevention services for drug misusers and the relationship between these and their involvement in service provision. DESIGN: Postal survey of a one in four random sample of community pharmacies (N = 2654) in England and Wales, stratified by Family Health Service Authority, in 1995, using up to four mailshots. SETTING: Community pharmacies in England and Wales. PARTICIPANTS: The community pharmacist in charge of the dispensary at the random sample of community pharmacies. MEASUREMENTS: Information on attitudes and behaviour were collected through self-completion and postal return of structured questionnaires using questions with both category responses and Likert scales. FINDINGS: A 74.8% response rate was achieved. Community pharmacists were positive about their role in HIV prevention and the provision of clean injecting equipment to injecting drug users--positive attitudes that were more evident among those pharmacists already providing these services. However, they had concerns over the effect drug misusers may have on business and indicated a need for more training and for more role support. Only a minority had taken part in training on drug misuse and HIV prevention (34.7% and 21.3%, respectively). Many community pharmacists supported the proposal that there should be extensions of their involvement, to include services such as supervising the consumption of methadone in the pharmacy (38.6%) and collecting used prescribed ampoules from patients (33.8%). Positive relationships were identified between training and attitude, and between attitude and service provision. Changes in attitude responses between this 1995 survey and the earlier 1988 survey are also presented. CONCLUSIONS: Recommendations are made for further training and greater communication between prescriber/carer and the community pharmacists, for involvement of community pharmacies in new possible forms of service provision, and for there to be greater attention to the value of role support.

Attitude of Health Personnel↗
PubMed1996

Point prevalence of mental disorder in unconvicted male prisoners in England and Wales.

OBJECTIVES: To determine prevalence of mental disorder among male unconvicted prisoners and to assess the treatment needs of this population. DESIGN: Semi-structured interview and case note review of randomly selected cross section of male remand population. Non-attenders were replaced by the next name on prison roll. SETTING: Three young offenders' institutions and 13 adult men's prisons. SUBJECTS: 750 prisoners, representing 9.4% cross sectional sample of male unconvicted population. MAIN OUTCOME MEASURES: Prevalence of ICD-10 diagnoses of mental disorder, and associated treatment needs. RESULTS: Psychiatric disorder was diagnosed in 469 (63%) inmates. The main diagnoses were: substance misuse, 285 (38%); neurotic illness, 192 (26%); personality disorder, 84 (11%); psychosis, 36 (5%); other and uncertain, 36 (0.5%). Subjects could have more than one diagnosis. The average refusal rate was 18%. In total 414 inmates (55%) were judged to have an immediate treatment need: transfer to an NHS bed, 64 (9%); treatment by prison health care services, 131 (17%); motivational interviewing for substance misuse, 115 (15%); and therapeutic community placement, 104 (14%). CONCLUSIONS: Mental disorder was common among male unconvicted prisoners. Psychosis was present at four or five times the level found in the general population. Extrapolation of our results suggests that remand population as a whole probably contains about 680 men who need transfer to hospital for psychiatric treatment, including about 380 prisoners with serious mental illness.

Adult↗
PubMed1996

Mechanisms of cellular penetration and nuclear localization of an anti-double strand DNA autoantibody.

An anti-dsDNA Ab, mAb 3E10, was identified that bound membranes of fixed human renal tubular cells, penetrated live murine renal tubular cells in vivo, and localized in the cell nucleus. mAb 3E10 binds both dsDNA and an extracellular matrix protein, HP8/HEVIN, expressed in high endothelial venules. Previous studies showed both shared and distinct binding determinants of mAb 3E10 VH for DNA and HP8/HEVIN. To independently assess the requirement of DNA and HP8/HEVIN in cellular penetration, site-directed mutants of mAb 3E10 VH and V kappa were studied for penetrating kidney cell lines. The results showed that residues required for binding DNA, but not HP8/HEVIN, were necessary for Ab penetration, indicating that cellular penetration required the presence of DNA or binding of Ab to a membrane determinant precisely resembling DNA. Ab Fab penetrated cells, indicating that neither the Fc nor multivalent Ab binding is necessary for cellular penetration. Ab synthesized in the cytoplasm as a result of deleting heavy and light chain signal peptides was not translocated to the nucleus, indicating a mechanism distinct from the usual protein nuclear localization signals and suggesting the need for a membrane-mediated pathway or for post-translational modification of the Ab.

Animals↗
PubMed1996

Nucleic acid composition of bone marrow mononuclear cells in cobalamin deficiency.

Recent studies using anion exclusion chromatography have suggested that uracil is misincorporated into the DNA of patients with megaloblastic anemia to levels detectable by nonradioactive methods. We have investigated the nucleotide composition of DNA from the bone marrow mononuclear cells of eight patients with cobalamin deficiency and compared this with that found in normal subjects. The median level of uracil in the megaloblastic group was 0.082 mol% of cytosine (approx. 0.02 mol% of all bases in DNA), which was similar to that found in the control group (median 0.085 mol% of cytosine) and may be attributable, at least in part, to artefactual deamination of deoxycytidine monophosphate during the DNA hydrolysis. Our findings give no support for the view that, by overwhelming the uracil N-glycosidase mechanism, the degree of uracil misincorporation in megaloblastic anemia is sufficient to increase the steady state level of uracil in the DNA by amounts detectable by nonradioactive methods. Using high performance liquid chromatography, we have also demonstrated normal levels of methylcytosine in the DNA of megaloblastic subjects.

5-Methylcytosine↗
PubMed1996

Development of an aspect of executive control: development of the abilities to remember what I said and to "do as I say, not as I do".

Luria's tapping test (tap once when E taps twice, tap twice when E taps once) was administered to 160 children (80 males, 80 females) between 3 1/2 to 7 years old. Older children were faster and more accurate than younger children, with most of the improvement occurring by the age of 6. All children tested demonstrated understanding of the instructions during the pretest, and most started out performing well, but younger subjects could not sustain this. Over the 16 trials, percentage of correct responses decreased, especially among younger subjects. Performance here was compared with performance on the day-night Stroop-like task. The most common error on both tasks was to comply with only one of the two rules. Other errors included tapping many times regardless of what the experimenter did and doing the same thing as the experimenter, rather than the opposite. It is suggested that the tapping task requires both the ability to hold two rules in mind and the ability to inhibit a strong response tendency, that these abilities improve between 3-6 years of age, and that this improvement may reflect important changes within frontal cortex during this period of life.

Aptitude↗
PubMed1996

Overexpression of human nucleolar proteins in insect cells: characterization of nucleolar protein p120.

Nucleolar p120 is a proliferation-associated protein, which becomes detectable early in the G1 phase of the cell cycle and peaks early in the S phase. A variety of human malignant tumor cells contain much higher levels of p120 than normal resting cells. The cellular functions of p120 are unknown, and little information is available on the structural characteristics of the human p120 protein. For biochemical characterization, human p120 protein was expressed in a baculovirus system and purified to approximately 95% purity. By indirect immunofluorescence, most of the recombinant human p120 as well as recombinant human B23, C23, or fibrillarin were localized to insect cell nucleoli and to large globular nuclear inclusions. Like endogenous p120 in HeLa cells, recombinant p120 expressed in insect cells was phosphorylated. On sucrose density gradients, p120 from HeLa cells sedimented in the 60-80S region, in which preribosomal particles sedimented using similar extraction and centrifugation procedures. The sedimentation of p120 shifted to the 5-10S region by treatment with 1 M KCl or with RNAse which suggests that p120 is bound to RNA.

Amino Acid Sequence↗
PubMed1996

Cloning and comparative mapping of a gene from the commonly deleted region of DiGeorge and Velocardiofacial syndromes conserved in C. elegans.

We have identified and cloned a gene, ES2, encoding a putative 476 amino acid protein with a predicted Mr of 52,568. The gene is localized within the DiGeorge/Velocardiofacial syndrome locus on 22q11.2 and is deleted in all the patients in which a deletion within 22q11 could be demonstrated, with the exception of one patient. ES2 is expressed in all the tissues studied. Sequence comparison showed identity with five ESTs and at the amino acid level the sequence was highly similar to, and collinear with, a hypothetical C. elegans protein of unknown function. Mutation analysis was performed in 16 patients without deletion, but no mutation has been found. The cDNA sequence is conserved in mouse and is localized on MMU16B1-B3, known to contain a syntenic group in common with HSA 22q11.2.

Abnormalities, Multiple↗
PubMed1996

The sperm deformity index: a reliable predictor of the outcome of oocyte fertilization in vitro.

OBJECTIVE: To evaluate a novel expression of sperm morphological parameters, the sperm deformity index, as a predictor of fertilization in vitro. DESIGN: Prospective blind clinical trial. SETTING: Academic tertiary referral center. INTERVENTION(S): Detailed sperm morphological assessment applying strict morphological criteria and a multiple entry technique for an unselected male population undergoing IVF. The sperm deformity index, defined as the average number of deformities per sperm assessed, was calculated. PATIENT(S): One hundred fifty-eight patients undergoing IVF treatment. Females with conditions negatively influencing fertilization were excluded. MAIN OUTCOME MEASURE(S): Fertilization rates and pregnancy. RESULT(S): Seventy-three percent of patients achieved fertilization. Patients achieving fertilization had a significantly higher median proportion of normal forms and a significantly lower median sperm deformity index than the nonfertilizers. The receiver operator characteristic (ROC) curves identified cutoff points that maximized the sum of sensitivity and specificity at sperm deformity index 1.6 and normal forms 4%. The sperm deformity index had a greater sensitivity (96%), specificity (72%), positive predictive value (90%), and negative predictive value (86%) than the proportion of normal sperm morphology (87%, 69%, 89%, 66%, respectively) at the optimal cutoff points. The area under the ROC curve was greater for the sperm deformity index (0.875) than for the proportion of normal sperm morphology (0.622). Achieving pregnancy did not correlated with sperm morphology. CONCLUSION(S): The sperm deformity index is a more reliable predictor of the outcome of fertilization in vitro than the proportion of normal sperm morphology and can assist to identify patients who require techniques such as intracytoplasmic sperm injection.

Adult↗
PubMed1996

Working with difficult-to-treat eating disorders using an integration of twelve-step and traditional psychotherapies.

In summary, we have a multidimensional treatment program that attempts to integrate psychodynamic, cognitive-behavioral, systemic, psychopharmacologic, and 12-step interventions. For patients who have not had previous treatments or patients who are young adolescents, we do not emphasize the 12-step approach. For our difficult-to-treat patients, our current overall impression is that the benefits of adding the 12-step component have outweighed the costs. We began the program with an expressed intent of experimenting with the integration. Staff were subsequently recruited who were open to the experiment and the success of the integration has been a function of the flexibility within the staff. Our hunch is that this integration would not work as well with an existing staff who harbored prejudice toward either position. Actually, we have found working on the integration quite invigorating. Our recovering counselors have raised issues that we have not heard raised in the more traditional settings we have been associated with. Likewise, we have seen our counselors grow professionally from hearing alternative views of why individuals struggle and how they get better. The exchange has been synergistic rather than divisive. Although we are encouraged by our early experience, it is the long-term outcome that will clarify the relative usefulness of this treatment strategy. We are confident that as we live with the integration longer, more of the advantages and disadvantages will become apparent and perhaps we can refine our understanding of which subgroup of patients makes most use of this type of integrated approach.

Feeding and Eating Disorders↗