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Biomedical subjects

G Johnston

Publications and source records attributed to G Johnston.

At least 19 recordsLinked to original sources
PubMed2004

Identity loss and maintenance: commonality of experience in cancer and dementia.

This paper examines parallel thematic findings from two qualitative studies exploring the experience of disease as it relates to cancer and dementia. The original studies examined the experiences of 16 individuals with cancer and 20 with dementia, and the impact of these first hand experiences and those of their principal family carers. The paper presents findings linked to the common or shared concepts of identity loss and maintenance as expressed by both the affected individual and the family carer.

Adaptation, Psychological↗
PubMed2002

Atopic dermatitis management: comparing the treatment patterns of dermatologists in Japan, U.S.A. and U.K.

BACKGROUND: The incidence of atopic dermatitis (AD) is increasing worldwide. No large-scale study has previously compared the therapeutic management of this condition in different countries. OBJECTIVES: The purpose of this study was to determine the treatment preferences of dermatologists in Japan, the U.S.A. and the U.K., and investigate their relationship with certain factors pertaining to the physician and his practice. METHODS: A questionnaire was sent to all registered members of dermatological societies in Japan, the U.S.A. and the U.K. Responses were collated and statistical analysis performed using chi2, Mantel-Haenszel and Breslow heterogeneity tests. RESULTS: Three thousand six hundred and eighty-eight completed surveys were returned. U.S.A. and U.K. physicians were significantly more aggressive in prescribing systemic medications, such as steroids, antibiotics and immunosuppressants, compared with those in Japan. Japanese dermatologists also utilized topical steroids significantly less. The use of alternative remedies was highest in Japan. All three countries had a relatively high degree of optimism for topical immunosuppressants, but less so for other emerging therapies. CONCLUSIONS: Both similarities and differences in the therapy of AD exist in the three countries studied. Factors related to the physician, patient population and culture may influence these observations.

Adult↗
PubMed2001

Hospital reconfiguration. Going places.

Two major hospital moves in Lanarkshire were completed smoothly by predicting the number of emergency admissions likely over the crucial periods and involving GPs and all the hospitals concerned. An analysis of emergency admissions was one factor in deciding which days the moves should take place on. A workshop after the first move was finished proved important.

Continuity of Patient Care↗
PubMed2001

Aspiration and regurgitation prophylaxis in paediatric anaesthesia.

BACKGROUND: Surveys of aspiration prophylaxis in paediatric anaesthesia do not exist. METHODS: A postal survey was sent out to all UK members of the Association of Paediatric Anaesthetists (APA) to assess current practice. We asked about minimum fasting times for liquids and solids/milk, their routine acid aspiration prophylaxis and perceived risk factors for emergency and elective surgery in children those less than 1 year old and those aged 1-14 years. We also asked if the APA member had more than 10 years experience in paediatric anaesthesia. RESULTS: One hundred and two (55.1%) APA members replied out of a total of 185 questionnaires sent. Eighty-eight (88/102) were considered valid. Fasting in emergencies is approximately 4 h for solids/milk and 2 h for clear liquids. Fasting for elective surgery is between 5 and 6 h for solids/milk and 2 h for clear liquids. Pharmacological methods to reduce the risk of aspiration are not used. Mechanical methods vary from 40-50% for cricoid pressure and 20-30% for nasogastric aspiration if a tube is present. The presence of a hiatus hernia is perceived by over 80% as a risk factor, previous aspiration by over 60%, difficult intubation, cerebral palsy and sepsis by 20-30%. CONCLUSION: Perceived risk factors vary with "experience": hiatus hernia, difficult intubation and cerebral palsy are less important whereas previous aspiration and renal failure appear to be more important for paediatric anaesthetists with less than 10 years in paediatric anaesthetic practice.

Adolescent↗
PubMed2001

Hydrogen peroxide activates NFkappaB and the interleukin-6 promoter through NFkappaB-inducing kinase.

Aging is associated not only with oxidant stress, but also with increased interleukin-6 (IL-6) levels. To determine if oxidative stress could contribute to the age-associated increase IL-6 expression, we exposed LNCaP prostate carcinoma cells and HeLa cervical carcinoma cells to H2O2 as an oxidant challenge. We found that H2O2 induced IL-6 expression through activation of the IL-6 promoter. Furthermore, H2O2-induced activation of the promoter was mediated through nuclear factor-kappaB (NFkappaB) secondary to H2O2-induced phosphorylation and degradation of IkappaBalpha. NFkappaB-inducing kinase (NIK) is upstream of the IkappaB kinase complex that induces IkappaBalpha degradation. Accordingly, we explored if H2O2 induces IL-6 expression through NIK. In addition to H2O2 inducing NIK autophosphorylation, transfection of LNCaP cells with a dominant negative NIK diminished H2O2-mediated NFkappaB and IL-6 promoter activity. Taken together, these results demonstrate that H2O2 induces the IL-6 promoter by activating NFkappaB through NIK. These data provide a candidate mechanism through which oxidant challenge induces IL-6 gene expression with age.

Active Transport, Cell Nucleus↗
PubMed2001

Increasingly inequitable distribution of general practitioners in Australia, 1986-96.

OBJECTIVE: To document trends in the distribution of general practitioners (GPs) in Australia between 1986 and 1996, adjusted for community need. METHODS: Data on the location of GPs, population size and crude mortality in statistical divisions (SD) were obtained from the Australian Bureau of Statistics Census of Population and Housing in 1986 and 1996. From these data, we calculated measures of distribution equality (number of people sharing each GP in each SD) and distribution equity (number of people sharing each GP divided by the crude mortality rate; the Robin Hood Index), and analysed temporal changes in the distribution of GPs. RESULTS: Nationally, the number of people sharing each GP fell 11% from 1,038 in 1986 to 921 in 1996. However, in 41 of 57 SDs (72%, p=0.01) the number of people sharing a GP actually increased over this time, and the average Robin Hood Index across SDs fell from 0.943 to 0.783 (p=0.004), indicating increasingly inequitable distribution. Comparing the Robin Hood Index values of all SDs ranked in pairs, the value fell in 53 of 57 (93%, p<0.001) paired SDs over the decade. These patterns demonstrate increasing inequity over the decade. The number of people sharing each GP was consistently and substantially lower in the capital city SDs and the Robin Hood Index values were consistently and substantially higher (overserved) compared with country SDs. CONCLUSIONS: Despite there being more GPs per capita in Australia, their distribution became increasingly unequal and inequitable between 1986 and 1996, such that rural and remote areas became increasingly poorly served.

Australia↗
PubMed2000

Neurotrophic role of interleukin-6 and soluble interleukin-6 receptors in N1E-115 neuroblastoma cells.

Interleukin 6 (IL-6) plays a role in physiological and pathophysiological processes in neuronal cells. We studied whether IL-6 plays a role in neuroblastoma cells in culture. These studies demonstrate that N1E-115 cells constitutively express IL-6 but not IL-6R. Exogenous IL-6 stimulated neuronal proliferation in a dose-dependent manner. Under serum-free conditions soluble IL-6 receptors (sIL-6R) alone or in combination with IL-6 exerted significant proliferative effects, while IL-6 alone failed to promote cell proliferation. Neutralizing anti-IL-6 antibody caused a 30-40% reduction in IL-6 mediated proliferation. Our results suggest the importance of IL-6/sIL-6R for proliferation and survival of N1E-115 adrenergic neuroblastoma cells.

Animals↗
PubMed2000

Anaesthetic management of a 6-week-old child with unilateral pulmonary interstitial emphysema.

We report the case of a 6-week-old female infant suffering from respiratory distress related to cystic changes affecting the entire left lung. Anaesthesia was induced with sevoflurane in oxygen and spontaneous ventilation was maintained until intubation of the right main bronchus was secured. A left pneumonectomy was performed and the postoperative course was uneventful. The pathological diagnosis was pulmonary interstitial emphysema. This has not been previously reported in an otherwise normal child delivered uneventfully at term. The anaesthetic management of a child with a cystic lung lesion is discussed.

Anesthesia, Inhalation↗
PubMed2000

Reviewing audit: barriers and facilitating factors for effective clinical audit.

OBJECTIVE: To review the literature on the benefits and disadvantages of clinical and medical audit, and to assess the main facilitators and barriers to conducting the audit process. DESIGN: A comprehensive literature review was undertaken through a thorough review of Medline and CINAHL databases using the keywords of "audit", "audit of audits", and "evaluation of audits" and a handsearch of the indexes of relevant journals for key papers. RESULTS: Findings from 93 publications were reviewed. These ranged from single case studies of individual audit projects through retrospective reviews of departmental audit programmes to studies of interface projects between primary and secondary care. The studies reviewed incorporated the experiences of a wide variety of clinicians, from medical consultants to professionals allied to medicine and from those involved in unidisciplinary and multidisciplinary ventures. Perceived benefits of audit included improved communication among colleagues and other professional groups, improved patient care, increased professional satisfaction, and better administration. Some disadvantages of audit were perceived as diminished clinical ownership, fear of litigation, hierarchical and territorial suspicions, and professional isolation. The main barriers to clinical audit can be classified under five main headings. These are lack of resources, lack of expertise or advice in project design and analysis, problems between groups and group members, lack of an overall plan for audit, and organisational impediments. Key facilitating factors to audit were also identified: they included modern medical records systems, effective training, dedicated staff, protected time, structured programmes, and a shared dialogue between purchasers and providers. CONCLUSIONS: Clinical audit can be a valuable assistance to any programme which aims to improve the quality of health care and its delivery. Yet without a coherent strategy aimed at nurturing effective audits, valuable opportunities will be lost. Paying careful attention to the professional attitudes highlighted in this review may help audit to deliver on some of its promise.

Attitude of Health Personnel↗
PubMed2000

Pyogenic granuloma of the penis--don't squeeze them.

We report the case of a pyogenic granuloma on the shaft of the penis presenting with active bleeding secondary to attempted expression. Previously reported cases have documented such lesions on the prepuce and glans.

Adult↗
PubMed2000

Interprofessional learning modules at Dalhousie University.

Interprofessional education has been advocated to improve teamwork in the health sector. This paper reports on the first two years of operational experience by a School of Health Services Administration (SHSA) with three-hour interprofessional learning modules (IPLMs). SHSA students participated along with students from nursing, medicine, social work, physiotherapy, occupational therapy, pharmacy, speech language pathology, audiology, dental hygiene, dentistry, leisure studies, health education and kinesiology. The five IPLMs required for SHSA students were: professional roles and values, integrity in scholarly activity, disability, interpersonal violence and HIV/AIDS. This article describes the development, delivery and evaluation of these modules from an SHSA perspective. The IPLMs' evaluation findings indicated that IPLMs are worthwhile, but have taken years and ongoing senior management support to operationalize; inclusion of health services administration is worthwhile but challenging; vigilance is needed to retain an IP rather than module content focus; and faculty and facilitator development, along with student preparation and debriefing, is required. Student feedback was favourable; faculty members have gained by their involvement; and field practitioner support has been sustained. Evaluation and reflection are critical to IPLM evolution. The norms, strengths and constraints of the university must be taken into account, and thus IPLMs must be adapted for each educational setting. Schools of health services administration must decide whether they wish to be involved in interprofessional learning.

Allied Health Personnel↗
PubMed2000

Improving care or professional advantage? What makes clinicians do audit and how well do they fare?

OBJECTIVE: To find out why clinicians undertake audit, the extent to which they complete the process of audit and their perception of the benefits of taking part. DESIGN: Semi-structured interviews. SETTING: Twelve trusts in three Scottish Health Boards. SUBJECTS: One hundred and forty five respondents of different status from a wide range of clinical specialities. RESULTS: Sixty six per cent of respondents defined clinical audit as a means of making changes with a view to improving care, but 62% reported the purpose of audit as the examination of the usefulness of treatment or the observation of practice. Personal reasons for taking part included justifying practice (32%) and as a means of professional development (15%). Twenty one percent held formal minuted meetings, the majority were informal. Sixty six percent of clinicians completed a project plan but pilot studies (49%) and re-audits (26%) were less common. Twenty four percent changed practice as a result of the audit. The extent to which the audit process had been completed predicted clinicians' ability to make changes. CONCLUSION: Clinicians' understanding of the concept of audit was not translated into practical projects. The main reasons for this are the organisational difficulties clinicians are faced with when carrying out audit and a lack of attention to all parts of the audit process. Despite this failure to achieve change, many clinicians felt they had benefited from their experience of audit. Management should appeal to these motivations of employees and provide a culture which enforces their importance over and above changing practice.

Attitude of Health Personnel↗
PubMed1999

Guidelines for management of hypertension: report of the third working party of the British Hypertension Society.

Use non-pharmacological measures in all hypertensive and borderline hypertensive people. Initiate antihypertensive drug therapy in people with sustained systolic blood pressures (BP) >/=160 mm Hg or sustained diastolic BP >/=100 mm Hg. Decide on treatment in people with sustained systolic BP between 140 and 159 mm Hg or sustained diastolic BP between 90 and 99 mm Hg according to the presence or absence of target organ damage, cardiovascular disease or a 10-year coronary heart disease (CHD) risk of >/=15% according to the Joint British Societies CHD risk assessment programme/risk chart. In people with diabetes mellitus, initiate antihypertensive drug therapy if systolic BP is sustained >/=140 mm Hg or diastolic BP is sustained >/=90 mm Hg. In non-diabetic hypertensive people, optimal BP treatment targets are: systolic BP <140 mm Hg and diastolic BP <85 mm Hg. The minimum acceptable level of control (Audit Standard) recommended is <150/<90 mm Hg. Despite best practice, these levels will be difficult to achieve in some hypertensive people. In diabetic hypertensive people, optimal BP targets are; systolic BP <140 mm Hg and diastolic BP <80 mm Hg. The minimum acceptable level of control (Audit Standard) recommended is <140/<90 mm Hg. Despite best practice, these levels will be difficult to achieve in some people with diabetes and hypertension. In the absence of contraindications or compelling indications for other antihypertensive agents, low dose thiazide diuretics or beta-blockers are preferred as first-line therapy for the majority of hypertensive people. In the absence of compelling indications for beta-blockade, diuretics or long acting dihydropyridine calcium antagonists are preferred to beta-blockers in older subjects. Compelling indications and contraindications for all antihypertensive drug classes are specified. For most hypertensives, a combination of antihypertensive drugs will be required to achieve the recommended targets for blood pressure control. Other drugs that reduce cardiovascular risk must also be considered. These include aspirin for secondary prevention of cardiovascular disease, and primary prevention in treated hypertensive subjects over the age of 50 years who have a 10-year CHD risk >/=15% and in whom blood pressure is controlled to the audit standard. In accordance with existing British recommendations, statin therapy is recommended for hypertensive people with a total cholesterol >/=5 mmol/L and established vascular disease, or 10-year CHD risk >/=30% estimated from the Joint British Societies CHD risk chart. Glycaemic control should also be optimised in diabetic subjects. Specific advice is given on the management of hypertension in specific patient groups, ie, the elderly, ethnic subgroups, diabetes mellitus, chronic renal disease and in women (pregnancy, oral contraceptive use and hormone replacement therapy). Suggestions for the implementation and audit of these guidelines in primary care are provided.

Antihypertensive Agents↗
PubMed1999

Rib biopsy technique for cortical bone evaluation in rhesus monkeys (Macaca mulatta).

Old World primates are often studied to model human skeletal physiology. An important advantage of monkeys over other animal models (i.e., rodents) is the presence of cortical bone Haversian remodeling. Seventy-five female rhesus monkeys (Macaca mulatta) were subjected to bone biopsy. With monkeys in lateral decubitus position, the tenth rib was surgically exposed and freed from periosteum by use of careful sharp and blunt dissection. The rib section was resected, using bone cutters, and the surgical wound was closed. This procedure was repeated for the contralateral rib at a later time point in 65 monkeys. There was no mortality or appreciable morbidity. The bone specimens were (mean +/- SD) 2.50 +/- 0.25 cm long, with 5.5 +/- 1.0 mm2 total cross-sectional area. They were adequate for histologic, immunohistochemical, and quantitative histomorphometric examinations. Prevalence of pneumothorax was approximately 8.0% for the 140 procedures. This complication was immediately and successfully corrected by insertion of a small thoracic tube, evacuation of pneumothorax, and closure of the incision. This well-tolerated, repeatable procedure yields excellent specimens for performance of cortical bone histologic examination without euthanasia, allowing longitudinal evaluation.

Animals↗
PubMed1999

Raising the "glass ceiling" for ethnic minority women in health care management.

Ethnic minority women are well represented in the work force and in the health care system in general, but do not have a similar level of representation in the management sector. This paper explores three strategies for schools of health administration to consider to lessen the effect of a "glass ceiling" that may be encountered by ethnic minority women aspiring to positions of leadership in health services agencies. These strategies are advancing affirmative action, valuing ethnic women in health administration education, and investigating diversity management. Inherent in each of the three strategies is the need for acknowledgment and more open discussion of the "glass ceiling." Problem-solving in relation to the potential for systemic discrimination adversely affecting ethnic minority women in senior health care management positions, and greater study of the three strategies using both qualitative and quantitative methodologies is also needed.

Career Mobility↗