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J Douglas

Publications and source records attributed to J Douglas.

At least 55 records · Page 3Linked to original sources
PubMed1999

Measuring physician job satisfaction in a changing workplace and a challenging environment. SGIM Career Satisfaction Study Group. Society of General Internal Medicine.

BACKGROUND: Changes in the demographic, specialty, and employment sector composition of medicine have altered physicians' jobs, limiting autonomy and reducing morale. Because physician job satisfaction has been linked to clinical variables, better measurement might help to ameliorate conditions linked to medical disaffection, possibly improving health care. OBJECTIVE: To document conceptual development, item construction, and use of content experts in designing multidimensional measures of physician job satisfaction and global satisfaction scales for assessing physicians' job perceptions across settings and specialties. DESIGN: Using previous research, physician focus groups, secondary analysis of survey data, interviews with physician informants, and a multispecialty physician expert panel, distinct job facets and statements representing those facets were developed. RESULTS: Facets from previously validated instruments included autonomy, relationships with colleagues, relationships with patients, relationships with staff, pay, resources, and status. New facets included intrinsic satisfaction, free time away from work, administrative support, and community involvement. Physician status items were reconfigured into relationships with peers, patients, staff, and community, yielding 10 hypothetical facets. Global scales and items were developed representing satisfaction with job, career, and specialty. CONCLUSIONS: A comprehensive approach to assessing physician job satisfaction yielded 10 facets, some of which had not been previously identified, and generated a matching pool of items for subsequent use in field tests.

Attitude of Health Personnel↗
PubMed1999

Italy 1945.

Explore the source record for details and available documents.

Arteriosclerosis↗
PubMed1998

Homozygous deletions at 3p12 in breast and lung cancer.

We have constructed a physical map of the region homozygously deleted in the U2020 cell line at 3p12, including the location of putative CpG islands. Adjacent to one of these islands, we have identified and cloned a new gene (DUTT1) and used probes from this gene to detect two other homozygous deletions occurring in lung and breast carcinomas: the smallest deletion is within the gene itself and would result in a truncated protein. The DUTT1 gene is a member of the neural cell adhesion molecule family, although its widespread expression suggests it plays a less specialized role compared to other members of the family.

Breast Neoplasms↗
PubMed1998

Conversational discourse abilities following severe traumatic brain injury: a follow-up study.

The major aim of this study was to describe the conversational abilities of a group of severely injured TBI speakers, at a minimum of 2 years post-injury. The association between conversational impairment and (a) selected measures of executive function and (b) psychosocial handicap was also examined. Twenty-four members of the group of 26 severely injured TBI speakers who had initially been assessed between 3 and 6 months post-injury were reviewed at a minimum of 2 years post-injury (mean = 2 years, 10 months). At initial assessment, TBI speakers were compared with non-TBI orthopaedic patients and with a group of university students. At follow-up, however, they were compared only with the orthopaedic patients. Conversational assessment was carried out using a modified form of Damico's Clinical Discourse Analysis. As a group, the TBI speakers' conversational abilities did not improve over time. There was, however, a subgroup (n = 8) of speakers who did improve, and these could be distinguished by greater initial severity of injury and a significantly longer period of speech-language pathology intervention than the speakers who either remained the same or worsened over time. Modest associations between conversational discourse skills and measures of executive function and a measure of psychosocial handicap were identified. These findings indicate that disruptions in conversation persist into the longer term. More assiduous efforts may need to be made to (a) identify subtle discourse changes in the early months after injury and (b) engage TBI speakers in speech-language pathology services. Such services are also required over a longer time frame, in community-based models of service provision.

Adolescent↗
PubMed1997

Effects of alanine and glycine substitution for tryptophan on the heterogeneity of gramicidin A analogs in micelles.

The effects of alanine and glycine substitution for tryptophan upon the species heterogeneity of gramicidin A analogs incorporated into SDS micelles have been investigated. The sequential replacement of the four tryptophan residues in gramicidin A at positions 15, 13, 11, and 9 with glycine showed that there was no detectable effect at position 15 but increasing heterogeneity of species in the micelles proceeding toward the interior of the micelle at position 9. The replacement of tryptophan at positions 15 and 9 with alanine was found to produce more species heterogeneity than found with glycine substitution at the same positions. An increase in the SDS concentration reduces the number of different species present in micelles. With the Gly-11, Gly-13, and Gly-15 analogs, the increase in SDS concentration results in the formation of a single species; however, for the Gly-9, Ala-9, and Ala-15 analogs, heterogeneity remains.

Alanine↗
PubMed1997

Double-blind comparison of epidural ropivacaine 0.25% and bupivacaine 0.25%, for the relief of childbirth pain.

PURPOSE: To evaluate the efficacy of ropivacaine 0.25% when administered epidurally for relief of labour pain and to compare it with bupivacaine 0.25%. METHODS: In a multicentre investigation, 60 ASA I and II labouring women were randomized in a double-blind fashion to receive either bupivacaine 0.25% or ropivacaine 0.25% administered epidurally by intermittent top-up for labour analgesia. Using a standardized technique, epidural analgesia was initiated after the woman received 10-15 ml-kg.1 crystalloid solution. Maternal blood pressure, heart rate, analgesia sensory level, degree of motor block and visual analogue pain scores were measured by the research nurse prior to, and at regular intervals, following the administration of analgesia. Total dose of local anaesthetic administered, duration of labour, mode of delivery, and maternal and fetal/neonatal side effects were noted. The fetus/neonate was assessed by the research nurse using the fetal heart rate tracing, Apgar scores at delivery and neonatal neurobehavioural assessments at 2 and 24 hr postnatally. Maternal and investigators' satisfaction with the analgesia achieved was assessed after delivery. RESULTS: No differences were found between the two agents in any of the variables studied. CONCLUSION: Ropivacaine 0.25%, when administered epidurally by intermittent top-ups for labour analgesia, was equally efficacious as bupivacaine 0.25%.

Adolescent↗
PubMed1997

Conversational assessment following traumatic brain injury: a comparison across two control groups.

Although changes in discourse are frequently referred to in the traumatic brain injury (TBI) literature, they are difficult to objectify and measure. It is not always easy, therefore, for clinicians to differentiate between discourse behaviours which may have been present premorbidly, and those which are uniquely associated with TBI. The major aim of this study was to systematically examine and describe the nature of conversational impairment following severe TBI, with particular reference to the premorbid sociolinguistic characteristics of the TBI population. A second aim of the study was to examine the relationship between discourse impairment following TBI and severity of injury. Twenty-six TBI participants were compared with 26 non-brain-injured orthopaedic patients, and 26 university students, using Damico's Clinical Discourse Analysis (CDA). As predicted, global measures derived from the CDA did not differentiate the groups. The TBI group was, however, found to differ significantly from both control groups on a modified measure (CDA-M) which removes discourse errors that occurred with similar frequency across the three groups. Performance on this measure correlated significantly with severity of injury. Further, it was found that there were quantitative and qualitative differences between two seventy subgroups in the TBI group with respect to their CDA-M profiles. While nearly all members of the TBI group made errors associated with information transfer, only the more fundamental 'rules' of conversational interaction. The results are discussed in relation to the psychosocial implications of the findings, together with issues in sampling and measuring conversational discourse in the TBI population.

Adolescent↗
PubMed1997

Selective eaters: a retrospective case note study.

The literature on children who present with selective eating is limited to single case studies. This study aims to provide a descriptive clinical profile for these children. Case notes of 33 patients between 4 and 14 years of age, seen in two clinics over a 4-year-period were studied. Over two-thirds of the cases were boys. A significant minority had poor growth or weight gain. The children suffered from anxiety, obsessive compulsive symptoms, both food and non-food related and often had social and school difficulties. Mealtimes caused immense anxiety for family members and frequent mealtime battles was reported by the parents of the younger selective eaters, whereas parents of older children seemed to have given up trying to change their child's eating habits. A history of depression in at least one parent was found in a third of the parental couples.

Adolescent↗
PubMed1997

Cholera from raw seaweed transported from the Philippines to California.

In March 1994, a California woman without any recent travel developed acute, profuse, watery diarrhea. Her astute physician diagnosed cholera after ordering the appropriate stool culture, and the patient improved on an oral antibiotic. Epidemiologic investigation implicated seaweed from the Philippines that was transported by a friend to California and subsequently eaten raw as the vehicle of infection.

Adult↗
PubMed1997

Physician job satisfaction: developing a model using qualitative data. SGIM Career Satisfaction Study Group.

The purpose of this study was to develop a current and comprehensive model of physician job satisfaction. Information was gathered by (1) analysis of open-ended responses from a large group practice physician survey in 1988, and (2) analysis of focus group data of diverse physician subgroups from 1995. Participants were 302 physicians from large-group practices and 26 participants in six focus groups of HMO, women, minority, and inner-city physicians. Data were used to develop a comprehensive model of physician job satisfaction. The large group practice survey data supported the key importance of day-to-day practice environment and relationships with patients and physician peers. Future concerns focused on the effect of managed care on the physician-patient relationship and the ability of physicians to provide quality care. Focus groups provided contemporary data on physician job satisfaction, reinforcing the centrality of relationships as well as special issues for diverse physician subgroups of practicing physicians. New variables that relate to physician job satisfaction have emerged from economic and organizational changes in medicine and from increasing heterogeneity of physicians with respect to gender, ethnicity, and type of practice. A more comprehensive model of physician job satisfaction may enable individual physicians and health care organizations to better understand and improve physician work life.

Adult↗
PubMed1996

Dimensions of the impact of cancer pain in a four country sample: new information from multidimensional scaling.

We investigated the question of how cultural and linguistic backgrounds affect relationships among ratings (reported by patients with metastatic cancer) of pain's interference with such functions as activity, mood, and sleep. Multidimensional scaling (MDS) was used to analyze ratings of pain interference from a sample consisting of four culturally and linguistically different groups from the US (n = 1106), France (n = 324), the Philippines (n = 267), and China (n = 146). Patients all completed the Brief Pain Inventory, a self-report measure of pain and its interference with function. For each of these samples, MDS solutions consistently revealed two interpretable dimensions. In all samples, one dimension represented affect and the other dimension represented activity. The dimensions were consistently interpretable across all four samples and across three levels of pain severity ('mild', 'moderate', and 'severe'). The dimensions were most prominent when pain was moderate, rather than mild (when little interference was produced) or severe (when all domains were highly interfered with). These dimensions may have utility in the study of the epidemiology of pain and of the effectiveness of pain treatment. They may also be useful in clinical assessment to describe different patterns of pain interference.

China↗
PubMed1995

Response to demineralized bone matrix implantation in foals and adult horses.

Equine demineralized bone matrix, particle size 2 to 4 mm, was implanted SC and IM in 4 foals and 4 adult horses. The implants were removed between 5 and 8 weeks after implantation. Bone formation was induced by SC and IM implantations in all animals. The implantation site had a marked effect on the amount of bone that developed, bone being formed earlier and in greater amounts when the matrix was implanted IM. The amount of bone formed increased with increasing time after matrix implantation at both sites. Demineralized bone matrix implantation also led to formation of small amounts of chondroid tissue; this tissue was more common in IM than SC matrix implants, and increased in amount with increasing time after implantation. Formation of this chondroid tissue did not precede the formation of bone, and there was no evidence that implantation of demineralized bone matrix in horses induced endochondral ossification. Age of the host did not appear to affect the response.

Age Factors↗
PubMed1994

Transfusion of one HLA-DR antigen-matched blood to potential recipients of a renal allograft.

Patients awaiting a renal transplant were given 1 HLA-DR antigen-matched blood in order to compare the sensitization and graft outcome of these patients with those of control patients, who had been given random blood before transplantation. No differences in sensitization, measured by the formation of HLA antibodies, or in graft survival were found between the 2 groups. However, the incidence of rejection episodes was significantly reduced in the patients who received blood matched for 1 HLA-DR antigen compared with the patients who received random blood.

Blood Grouping and Crossmatching↗
PubMed1994

Identification of positive and negative transcriptional regulatory elements of the rabbit angiotensin-converting enzyme gene.

The two tissue-specific mRNAs encoding the isozymes of rabbit angiotensin-converting enzyme (ACE) are generated from the same gene by alternative choice of two transcription initiation sites 5.7 kb apart. In the current study, we have characterized the regulatory sites controlling the transcription of the larger pulmonary isozyme mRNA. For this purpose, reporter genes driven by varying lengths of upstream region of the ACE gene were transfected into ACE-producing cells. Our results demonstrated that the transcription of this gene is primarily driven by positive elements within the first 274 bp DNA upstream of the transcription initiation site. The reporter gene driven by this region was expressed in two ACE-producing cells but not in two ACE-non-producing cells thereby establishing its tissue specificity. Our experiments also revealed the existence of a strong negative element located between -692 and -610 positions. This element suppressed the expression of the reporter gene in a dose-dependent and position and orientation-independent fashion thus suggesting that it is a true silencer element. It could also repress the expression of a reporter gene driven by the heterologous strong promoter of the beta-actin gene. The repressing effects of the negative element could be partially overcome by cotransfecting the isolated negative element along with the reporter gene containing the negative element. This result was possibly due to the functional removal of a limiting trans-acting factor which binds to this element. Electrophoretic mobility shift assays revealed that the negative element can form several complexes with proteins present in the nuclear extract of an ACE-producing cell line. At least part of the negative element is strongly conserved in the upstream regions of the human and mouse ACE genes.

Animals↗
PubMed1994

Effect of preoperative skin infiltration with 0.5% bupivacaine on postoperative pain following cesarean section under spinal anesthesia.

Recent work suggests that preoperative skin infiltration with local anesthetic may lead to reduced postoperative pain. We have studied this in a randomised, prospective, double-blind trial of 40 women having cesarean section under spinal anesthesia. After establishment of the spinal block, the incision line was infiltrated in 20 women with 30 ml 0.5% bupivacaine and in 20 with 30 ml normal saline. There was no difference in pain scores between the 2 groups on any of the 3 postoperative days, perhaps due to the high quality analgesia provided by supplemental subarachnoid morphine.

Journal Article↗