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Biomedical subjects

J Morrison

Publications and source records attributed to J Morrison.

At least 19 recordsLinked to original sources
PubMed2006

Coupling mechanism of an EMAT.

Electro-magnetic acoustic transducers (EMATs) generate ultrasonic waves in metals through an electromagnetic coupling mechanism. A concept for EMAT generation, using a coil alone without a permanent magnet, but with a pulse generator and a sample, is introduced. A simplified equivalent coil circuit is given, and has been validated by experimental measurements. Such an equivalent circuit is useful for excitation current calculations, which have often been neglected in previous publications in this area but have proved to be of great importance in considering the efficiency and frequency characteristics of ultrasonic generation. Due to the coil sample coupling, the equivalent coil inductance is dependent on the electrical conductivity and magnetic permeability of the metal sample, the lift-off, the coil orientation relative to the metal sample and the coil configuration. The use of a coil alone to generate ultrasound has limited applications as a suitable ultrasonic detector must also be used, but where appropriate this type of generation source provides a robust, non-contact and inexpensive means of ultrasonic generation without worrying the permanent magnet attracting ferromagnetic particles that can prevent from practical on-line application of EMATs.

Journal Article↗
PubMed2006

Key clinical trials in gynaecological oncology.

AIMS: To review the most important clinical trials which have impacted the management of gynaecological cancers, in conjunction with some ongoing studies of interest. METHODS: PubMed and Cochrane databases were searched to find clinical trials and meta-analyses in vulva, cervical, endometrial and ovarian cancers. Other pertinent literature was also used. RESULTS: The majority of trials related to ovarian and cervical cancers, and the least associated with vulval cancer. CONCLUSIONS: To ensure evidence based medicine, trials in gynaecological cancers must be supported. Notably, surgical trials are on the increase in the last decade, but are still a minority when compared with non-surgical interventions.

Clinical Trials as Topic↗
PubMed2006

The outcomes of an intervention study to reduce the barriers experienced by people with intellectual disabilities accessing primary health care services.

BACKGROUND: People with intellectual disabilities (IDs) experience significant health inequalities compared with the general population. The barriers people with IDs experience in accessing services contribute to these health inequalities. Professionals' significant unmet training needs are an important barrier to people with IDs accessing appropriate services to meet their health needs. METHOD: A three group, pre- and post-intervention design was used to test the hypothesis that a training intervention for primary health care professionals would increase the knowledge and self-efficacy of participants. The intervention had two components - a written training pack and a 3-hour face-to-face training event. One group received the training pack and attended the training event, a second group received the training pack only, and a third group did not participate in the training intervention. Research measures were taken prior to the intervention and 3 months after the intervention. Statistical comparisons were made between the three groups. RESULTS: The participants in the training intervention reported that it had a positive impact upon their knowledge, skills and clinical practice. As a result of the intervention, 35 (81.4%) respondents agreed that they were more able to meet the needs of their clients with IDs, and 33 (66.6%) reported that they had made changes to their clinical practice. The research demonstrated that the intervention produced a statistically significant increase in the knowledge of participants (F = 5.6, P = 0.005), compared with the group that did not participate in the intervention. The self-efficacy of the participants that received both components of the intervention was significantly greater than the group that did not participate in the training (t = 2.079, P = 0.04). Participation in the two components of the training intervention was associated with significantly greater change in knowledge and self-efficacy than those receiving the training pack alone. CONCLUSION: This intervention was effective in addressing the measured training needs of primary health care professionals. Future research should directly evaluate the positive benefits of interventions on the lives of people with IDs.

Attitude of Health Personnel↗
PubMed2006

Improving the health of people with intellectual disabilities: outcomes of a health screening programme after 1 year.

BACKGROUND: People with intellectual disabilities (IDs) have a higher level of health needs, a higher level of which is unmet, compared with the general population. Health screening can detect unmet health needs, but it is unknown whether it effects beneficial health outcomes in the longer term. People with IDs are reliant on health management by proxy and there are many potential access barriers that may prevent health needs identified at screening from subsequently being met. This study aims to determine whether health gains can be detected 1 year after a health screening programme specific to the needs of adults with IDs. METHODS: A total of 50 participants offered the health screen intervention were individually matched for gender, age and level of IDs with 50 control participants who received standard treatment only. Outcome measures after 1 year were semi-structured review of medical case notes, and semi-structured assessment with the people with IDs and their carer. RESULTS: During the 1-year period, the incidence of health need detection was more than twice as great for intervention, compared with control participants (mean number of new needs was 4.80 compared with 2.26; P < 0.001), and the level of met new health needs was greater (mean of 3.56 compared with 2.26; P = 0.001). The level of met health promotion needs was also greater (P < 0.001), and more health monitoring needs were met for intervention compared with control participants (P = 0.039). CONCLUSIONS: This is the first study to demonstrate sustained benefits in health outcomes from a clinical intervention for adults with IDs compared with standard treatment alone. Its routine implementation is feasible, and would reduce health inequalities.

Adult↗
PubMed2005

Enhancing primary health care services for adults with intellectual disabilities.

BACKGROUND: Primary health care teams have an important part to play in addressing the health inequalities and high levels of unmet health needs experienced by people with intellectual disabilities (ID). Practice nurses have an expanding role within primary health care teams. However, no previous studies have measured their attitudes, knowledge, training needs, and self-efficacy in their work with people with ID. METHODS: All practice nurses working in a defined area were identified. A purpose-designed questionnaire to measure nurse attitudes, knowledge, training needs and self-efficacy was developed and piloted. All practice nurses were then invited to participate. Data from completed questionnaires were entered onto PC and analysed. RESULTS: Of a total of 292 practice nurses 201 (69%) participated. Whilst 89% (n=179) of participants reported having infrequent contact, 25% (n=50) reported a growing workload with people with ID. Only 8% (n=16) had ever received any training in communicating with people with ID. A knowledge gap regarding the health needs of people with ID was identified. Eighty-six per cent reported having experienced specific difficulties during previous appointments, and only 23% thought they had sufficient case note information at appointments, but 68% did not modify the duration of their appointments with people with ID. Conversely, responses demonstrated that practice nurses have a high level of experience and qualification in general nursing, have positive attitudes to working with people with ID, and high self-efficacy scores were identified for work with people with ID. The practice nurses viewed ID to be a high priority area for future training. CONCLUSIONS: Primary health care teams have a key role in tackling the unmet health needs of people with ID. Whilst this project has identified factors that may impact on the accessibility of services, it has also identified practice nurses as having positive attitudes and high self-efficacy scores in their work with people with ID. This indicates that they should be targeted for specific training in this area, which may make an important contribution in enhancing future accessibility of primary health care services for people with ID.

Adult↗
PubMed2005

Advocacy in practice: the experiences of independent advocates on UK mental health wards.

Independent advocacy in mental health has become increasingly valued in the UK although little work has examined the day-to-day experiences of advocates themselves. This article reports on a small-scale exploratory qualitative study of practising advocates' experiences of their work in acute and continuing care wards. The project results from collaboration between members of the UK Advocacy Network and the Department of Mental Health and Learning Disability at the University of Sheffield. Although the findings will be of interest to any professional allied to these areas they are particularly relevant to mental health nurses wishing to increase their knowledge of advocacy and gain a fresh perspective on inpatient care. The findings reveal difficulties inherent in advocacy practice as well as the nature and importance of good working relationships between advocates and clinicians. Despite acknowledging such relationships frequently exist, advocates can still encounter ignorance of their role and opposition to their presence. The clearest implication of the findings is the need for greater training of nurses and other clinicians in the role of the advocate.

Attitude of Health Personnel↗
PubMed2005

Whose information is it anyway? Informing a 12-year-old patient of her terminal prognosis.

OBJECTIVE: To examine students' attitudes and potential behaviour towards informing a 12-year-old patient of her terminal prognosis in a situation in which her parents do not wish her to be told, as they pass through a modern medical curriculum. DESIGN: A cohort study of students entering Glasgow University's new medical curriculum in October 1996. METHODS: Students' responses obtained before year 1 and at the end of years 1, 3, and 5 to the "childhood leukaemia" vignette of the Ethics in Health Care Survey Instrument (EHCI) were examined quantitatively and qualitatively. Analysis of the students' multichoice answers enabled measurement of the movement towards professional consensus opinion. An analysis of their written justifications for their answers helped to determine whether their reasoning was consistent with professional consensus and enabled measurement of changes in knowledge content and recognition of the values inherent in the vignette. Themes on the students' reasoning behind their decision to tell the patient or not were also identified. RESULTS: Unlike other vignettes of the EHCI in which autonomy was a main theme, few students chose the consensus answer before year 1 and there was no significant movement towards consensus at any point during the course. In defence of their decision to withhold information, the students expressed strong paternalistic opinions. The patient's age was seen as a barrier to respecting her autonomy. CONCLUSIONS: It is important to identify students' perceptions on entry to medical school. Transformative learning theory may provide the basis for an approach to foster doctors who consider the rights of young people. Small-group teaching is most conducive to this approach. The importance of positive role modelling is also emphasised.

Age Factors↗
PubMed2005

Problem-based, peer-facilitated education about antibiotic prescribing.

AIMS: To assess the feasibility and acceptability of a problem-based, peer-facilitated educational workshop about antibiotic prescribingfor GPs. METHOD PARTICIPANTS: All 39 GPs working in an average sized Local Health Care Co-operative (LHCC) in Glasgow. INTERVENTION: Prospective collection of information about 10 prescriptions for antibiotics to assess learning needs in relation to antibiotic prescribing. Two and a half hour workshop involving problem-based group work based on the needs assessment and discussions with a consultant microbiologist, prescribing adviser and academic GP. EVALUATION: Written feedback about the process of the educational intervention immediately after the workshop and outcome feedback collected after four weeks. Telephone interviews with non-participants. RESULTS: Twenty-four GPs agreed to participate in the study. 19 of these completed the Needs Assessment and 14 of these completed the workshop. The method of learning needs assessment and the educational workshop were highly acceptable. "No time, too busy" was the main reason given for not taking part in the study. CONCLUSION: Some GPs are unable to participate as fully as they would like in continuing professional learning activities due to competing workload pressures. Further research is required to investigate the necessary type and balance of learning activities and the barriers to engagement to ensure the most effective use of clinician time available for continuing educational activities.

Adult↗
PubMed2004

Monitoring Aspergillus species by quantitative PCR during construction of a multi-storey hospital building.

During the enlargement of an existing hospital, quantitative polymerase chain reaction (PCR) was used to monitor Aspergillus spp. populations within the construction site. The rapid availability of results meant that the construction schedule was largely uninterrupted, while assuring that the new construction was free from contamination by the targeted Aspergillus spp.

Aspergillus↗
PubMed2004

General practitioners' educational needs in intellectual disability health.

BACKGROUND: The community general practitioner (GP) has a central role in the provision of primary health care to people with intellectual disability (ID) as an indirect result of deinstitutionalization in Australia. This population, however, continues to experience poor health care compared to the general population. The current paper describes results from a questionnaire that aimed to identify the perceptions of practising GPs on the standards of health care for people with ID, the adequacy of prior training, and their interest in further education in relation to nine health care areas. METHOD: A questionnaire was posted to a selective sample of 1272 practising GPs in Victoria selected from a database from the Centre for Developmental Disability Health Victoria and the Victorian Medical Directory of GPs registered with the Australian Medical Association. Data were available for 252 respondents with a response rate of 28.5%. RESULTS: The health areas in which many GPs reported to be inadequately trained were the same as those areas that were perceived as being of a poor standard. These areas were behavioural or psychiatric conditions, human relations and sexuality issues, complex medical problems, and preventative and primary health care. Ninety four per cent of respondents were interested in further education in at least one of the nine health care areas, with the most frequently nominated areas being behavioural or psychiatric conditions, syndrome-specific medical problems, human relations and sexuality issues and collaboration with government services. General practitioners did not nominate complex medical problems or preventative and primary health care for further education as frequently as they identified care in these areas to be substandard and their prior training inadequate. CONCLUSIONS: The findings from the current research are discussed in relation to the implications for development of educational programmes based on learning needs identified by the GP. The most frequently nominated health care areas in all three questions were behavioural or psychiatric conditions and human relations and sexuality issues. Reasons for incongruence between the frequency of responses for complex medical problems and preventative and primary health care are explored.

Behavior Therapy↗
PubMed2004

Students' attitudes and potential behaviour to a competent patient's request for withdrawal of treatment as they pass through a modern medical curriculum.

OBJECTIVE: To examine students' attitudes and potential behaviour to a competent patient's request for withdrawal of treatment as they pass through a modern medical curriculum. DESIGN: Cohort design. SETTING: University of Glasgow Medical School, United Kingdom. SUBJECTS: A cohort of students entering Glasgow University's new learner centred, integrated medical curriculum in October 1996. METHODS: Students' responses before and after year 1, after year 3, and after year 5 to the assisted suicide vignette of the Ethics in Health Care Survey instrument, were examined quantitatively and qualitatively. Analysis of students' multichoice answers enabled measurement of the movement towards professional consensus opinion. Analysis of written justifications helped determine whether their reasoning was consistent with professional consensus and enabled measurement of change in knowledge content and recognition of the values inherent in the vignette. Themes on students' reasoning behind their decision to withdraw treatment or not were also identified. RESULTS: Students' answers were found to be consistent with professional consensus opinion precurriculum and remained so throughout the curriculum. There was an improvement in the knowledge content of the written responses following the first year of the curriculum, which was sustained postcurriculum. However, students were found to analyse the section mainly in terms of autonomy, with few responses considering the other main ethical principles or the wider ethical perspective. Students were unclear on their legal responsibilities. CONCLUSIONS: Students should be encouraged to consider all relevant ethical principles and the wider ethical perspective when deliberating ethical dilemmas. Students should have a clear understanding of their legal responsibilities.

Adult↗
PubMed2004

Sex and the surgery: students' attitudes and potential behaviour as they pass through a modern medical curriculum.

OBJECTIVE: To examine students' attitudes and potential behaviour to a possible intimate relationship with a patient as they pass through a modern medical curriculum. DESIGN: A cohort study of students entering Glasgow University's new learner centred, integrated medical curriculum in October 1996. METHODS: Students' pre year 1 and post year 1, post year 3, and post year 5 responses to the "attractive patient" vignette of the Ethics in Health Care Survey instrument were examined quantitatively and qualitatively. Analysis of students' multi-choice answers enabled measurement of the movement towards professional consensus opinion. Analysis of written justifications helped determine whether their reasoning was consistent with professional consensus and enabled measurement of change in knowledge content and recognition of the values inherent in the vignette. Themes on students' reasoning behind their decision to enter a relationship or not were also identified. RESULTS: No significant movement towards consensus was found at any point in the curriculum. There was little improvement in students' performance in terms of knowledge content and their abilities to recognise the values inherent in the vignette. In deciding to enter a relationship with the patient the most frequently used reasoning was that it could be justified if the patient changed their doctor. CONCLUSIONS: Teaching on the subject of sexual or improper relationships between doctors and patients, including relationships with former patients requires to be made explicit. Case based teaching would fit in with the ethos of the problem based, integrated medical curriculum.

Adult↗
PubMed2003

Negative self-imagery blocks inferences.

Previous research has shown that, unlike non-anxious individuals, people with social phobia fail to generate non-threatening inferences when ambiguous social information is first encountered (i.e. 'on-line'; Hirsch and Mathews Journal of Abnormal Psychology, 109 (2000) 705-712). Patients with social phobia also report negative self-imagery in social situations, while individuals without high social anxiety do not. The negative self-imagery in social phobia may prevent the generation of non-threatening inferences. If so, then training non-anxious individuals to hold in mind a negative self-image should remove the 'on-line' non-threat inferential bias normally evident in this population. In the present study, low anxious volunteers were allocated to negative image training or a control task that did not manipulate self-imagery. Following negative image training, or the control task, volunteers read descriptions of job interviews and at certain points during the text performed lexical decisions. Some decisions were made after ambiguous text that could have been interpreted in both a threatening and a non-threatening manner. In a baseline condition, decisions were made following the text for which there was only one possible inference (either threat or non-threat). The results for the control group replicated earlier findings of a non-threat inferential bias for non-anxious individuals. In contrast, and as predicted, non-anxious volunteers who were trained to hold a negative image in mind lacked any non-threatening inferential bias, and also experienced higher levels of state anxiety.

Adult↗
PubMed2001

On-line high-precision stable hydrogen isotopic analyses on nanoliter water samples.

We describe a new on-line chromium reduction technique for the measurement of stable hydrogen (deltaD) isotopes in waters using continuous-flow isotope ratio mass spectrometry. The on-line Cr reduction method has low intersample memory effects (< 1%) and excellent precision and accuracy for deltaD (+/-0.5% and was used to analyze waters samples as small as 50 nL. The on-line Cr method has a number of significant advantages over conventional offline Zn and U reduction and on-line carbon-based pyrolysis techniques. A single Cr reactor can be used to analyze approximately 1,000 water samples using an injection volume of 0.5 microL, with an individual sample analysis time of 4 min. Intersample memory effects are negligible. The Cr reactor temperature of 1050 degree C is easily attainable on standard elemental analyzers and so does not require the specialized and costly high-temperature furnaces of carbon-based pyrolysis reactors. Furthermore, hydrogen isotopes in extremely small water samples in the 100-nL range or less can be easily measured; hence, this new method opens up a number of exciting application areas in earth and environmental sciences, for example, natural abundance deltaD measurements of individual fluid inclusions in geologic materials using a laser source and measurements of body fluids in physiological and metabolic research.

Algorithms↗
PubMed2001

Pragmatic randomised controlled trial to evaluate guidelines for the management of infertility across the primary care-secondary care interface.

OBJECTIVE: To investigate the effect of clinical guidelines on the management of infertility across the primary care-secondary care interface. DESIGN: Cluster randomised controlled trial. SETTING: General practices and NHS hospitals accepting referrals for infertility in the Greater Glasgow Health Board area. PARTICIPANTS: All 221 general practices in Glasgow; 214 completed the trial. INTERVENTION: General practices in the intervention arm received clinical guidelines developed locally. Control practices received them one year later. Dissemination of the guidelines included educational meetings. MAIN OUTCOME MEASURES: The time from presentation to referral, investigations completed in general practice, the number and content of visits as a hospital outpatient, the time to reach a management plan, and costs for referrals from the two groups. RESULTS: Data on 689 referrals were collected. No significant difference was found in referral rates for infertility. Fewer than 1% of couples were referred inappropriately early. Referrals from intervention practices were significantly more likely to have all relevant investigations carried out (odds ratio 1.32, 95% confidence interval 1.00 to 1.75, P=0.025). 70% of measurements of serum progesterone concentrations during the midluteal phase and 34% of semen analyses were repeated at least once in hospital, despite having been recorded as normal when checked in general practice. No difference was found in the proportion of referrals in which a management plan was reached within one year or in the mean duration between first appointment and date of management plan. NHS costs were not significantly affected. CONCLUSIONS: Dissemination of infertility guidelines by commonly used methods results in a modest increase in referrals having recommended investigations completed in general practice, but there are no detectable differences in outcome for patients or reduction in costs. Clinicians in secondary care tended to fail to respond to changes in referral practice by doctors. Guidelines that aim to improve the referral process need to be disseminated and implemented so as to lead to changes in both primary care and secondary care.

Cost-Benefit Analysis↗