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Biomedical subjects

M Whitfield

Publications and source records attributed to M Whitfield.

At least 19 recordsLinked to original sources
PubMed2006

Assessment of internet use and effects among healthcare professionals: a cross sectional survey.

PURPOSE: Several studies have explored the scientific platforms on patient use of the internet for health information. In contrast physicians' perspective on evolving internet environment is lacking. The purpose of this study is to assess and correlate the extent of internet use among healthcare professionals and examine its effects on clinical practice. METHODS: Cross sectional survey conducted in the USA using questionnaires distributed randomly to healthcare professionals attending distinct continuing medical education programmes between 2003 and 2004. Multiple choice and yes/no questions related to the trends of internet use and its effects on clinical practice were extracted and responses analysed. The main outcome measures are self reported rates of internet use, perceived effects, and the role of medical web sites in clinical practice. RESULTS: The overall response rate was 60%. A total of 277 survey respondents (97%) had internet access. Some 7% in private practice and 1% of group practice physicians did not have internet access. Most (71%) used the internet regularly for medical or professional updating and 62% (n = 178) felt the need for sharing web sites designed for healthcare professionals with patients. Some 27% of the physicians currently own established personal practice web sites. Sixty three per cent have recommended a web site to a patient for more information, matching the positive trust (>70%) on the general quality of selected medical web sites. CONCLUSION: This cross sectional survey shows that internet use and web based medical information is widely popular among physicians and patients. About 23%-31% of the healthcare professionals report >80% interaction with web informed patients in their daily practice.

Adult↗
PubMed2000

Characterization of the histone H1-binding protein, NASP, as a cell cycle-regulated somatic protein.

Nuclear autoantigenic sperm protein (NASP), initially described as a highly autoimmunogenic testis and sperm-specific protein, is a histone-binding protein that is a homologue of the N1/N2 gene expressed in oocytes of Xenopus laevis. Here, we report a somatic form of NASP (sNASP) present in all mitotic cells examined, including mouse embryonic cells and several mouse and human tissue culture cell lines. Affinity chromatography and histone isolation demonstrate that NASP from myeloma cells is complexed only with H1, linker histones. Somatic NASP is a shorter version of testicular NASP (tNASP) with two deletions in the coding region arising from alternative splicing and differs from tNASP in its 5' untranslated regions. We examined the relationship between NASP mRNA expression and the cell cycle and report that in cultures of synchronized mouse 3T3 cells and HeLa cells sNASP mRNA levels increase during S-phase and decline in G(2), concomitant with histone mRNA levels. NASP protein levels remain stable in these cells but become undetectable in confluent cultures of nondividing CV-1 cells and in nonmitotic cells in various body tissues. Expression of sNASP mRNA is regulated during the cell cycle and, consistent with a role as a histone transport protein, NASP mRNA expression parallels histone mRNA expression.

Amino Acid Sequence↗
PubMed1998

Choice of NSAID and management strategy in rheumatoid arthritis and osteoarthritis. The impact on costs and outcomes in the UK.

OBJECTIVE: Although nonsteroidal anti-inflammatory drugs (NSAIDs) are an effective therapy for rheumatoid arthritis, they are associated with significant adverse effects, the management of which imposes additional costs on the healthcare system. Prescribing NSAIDs which have a lower risk of major adverse effects as the first-line NSAID for patients with rheumatoid arthritis and osteoarthritis may be expected to lead to an improvement in clinical outcomes and reduce overall treatment costs. This analysis examines data from a published randomised controlled trial of 5 NSAIDs to explore these hypotheses. DESIGN AND SETTING: Data from a clinical trial comparing 5 NSAIDs were combined with published cost data to construct 2 clinical decision models, reflecting alternative approaches to the management of major and minor adverse effects in the UK. INTERVENTIONS: The 5 NSAIDs evaluated in the analysis were nabumetone, diclofenac, ibuprofen, piroxicam and naproxen, although only the results for ibuprofen and nabumetone are reported. MAIN OUTCOME MEASURES AND RESULTS: The total cost of care per patient receiving nabumetone was estimated to be between 25 pounds sterling (Pound) and 41 Pounds more expensive than ibuprofen. In a hypothetical cohort of 100,000 patients, there were between 690 and 821 more major adverse effects using ibuprofen than nabumetone. The cost per life-year gained (LYG) from using nabumetone rather than ibuprofen ranged between 1880 Pounds and 2517 Pounds (1995 values), depending upon the management of adverse effects. CONCLUSIONS: These results indicate that: (i) prescribing the newer, currently more expensive, NSAIDs will not necessarily lead to cost savings; (ii) the management of adverse effects can have a significant impact on costs; and (iii) the additional cost may be justifiable in terms of the mortality and morbidity gains associated with the new lower-risk NSAIDs.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1997

Hypertension management in general practice.

The views of 542 general practitioners (GPs) and 64 consultant physicians about the management of patients with hypertension in general practice were sought by postal questionnaire. 325 (60%) of the GPs and 45 (70%) of the consultant physicians completed the questionnaire. For a 40-year-old man with no other cardiovascular risk factors most general practitioners would intervene with drugs at blood pressure levels specified in published guidelines, whereas many local consultants and older GPs would consider drug treatment at lower levels. About 75% of GPs, compared with 87% of consultants, would suggest drug treatment in a woman of 70 years with a BP of 180/100 mmHg. Although consultants tended to expect GPs to order more tests when investigating a patient with hypertension than the GPs actually did, both GPs and consultants would order similar types of investigations apart from imaging. Consultants had different expectations about the frequency with which general practitioners should record patients' blood pressure and the GPs' ability to prevent cardiovascular events in hypertensive patients. Many older GPs and consultants seem to have unrealistic expectations of the value of treating patients with hypertension.

Adult↗
PubMed1997

Giving feedback to questionnaire responders--an essential task?

Giving a quick feedback to responders of questionnaires, indicating how responders' views are similar to or different from the views expressed by their peers, could be considered good practice. It is relatively easy to produce feedback by using the research database and mail-merging a document with conventional word-processing software. Producing this type of feedback is likely to increase the respondent's involvement in a project and may even improve the quality of response.

Attitude of Health Personnel↗
PubMed1997

A randomized controlled trial of antibiotics on symptom resolution in patients presenting to their general practitioner with a sore throat.

BACKGROUND: Sore throat is a common symptom presented to general practitioners (GPs), and there remains controversy about the appropriate use of antibiotics. AIM: To compare, in a randomized controlled trial, the effectiveness of penicillin, cefixime and placebo on symptom resolution in patients presenting with a sore throat in general practice. METHOD: Twenty-two GPs in Avon recruited 154 patients, aged 16-60 years, presenting to their GP with a sore throat, and for whom the GP would normally prescribe an antibiotic. Patients were randomized to one of three groups: penicillin V 250 mg four times a day; cefixime 200 mg daily; and placebo. Each was prescribed for five days. The main outcome measures were a diary of symptom resolution over seven days and eradication of group A beta-haemolytic streptococcus (GABHS). RESULTS: Of the 103 (67%) patients who completed symptom diaries, 40 were allocated to receive penicillin, 29 cefixime and 34 placebo. In the analysis including all patients, symptom resolution was greater by day 3 in the cefixime group than in the placebo group. Penicillin did not improve symptom resolution by day 3 compared with placebo, and cefixime was not statistically significantly different from penicillin. There were significant differences in the proportion of patients using analgesia at day 3, with the proportion being lowest in the cefixime group. The results for the subgroup of patients without GABHS were similar to those for all patients; in particular, the only statistically significant difference was between cefixime and placebo. Although numbers were too small for statistical significance, among patients with GABHS the effects of penicillin and cefixime were similarly raised in relation to placebo. CONCLUSION: Compared with placebo, cefixime can improve the rate of resolution of symptoms in patients with a sore throat who are selected for antibiotic treatment by their GP. The unexpected finding that cefixime was of benefit compared with placebo for patients without GABHS suggests that bacteria other than GABHS may be important in the pathogenesis of sore throat.

Adolescent↗
PubMed1996

Assessing general practitioners' care of adult patients with learning disability: case-control study.

OBJECTIVE: To compare general practitioners' care of adult patients with learning disability with that of control patients in the same practice. DESIGN: Case-control study of patients and controls by a structured interview study of general practitioners. SETTING: Avon. PATIENTS: 78 adult patients with learning disability and 78 age and sex matched controls--cared for by 62 general practitioners. MAIN MEASURES: Number and content of consultations and opinions of the general practitioners. RESULTS: There were more consultations for diseases of the central nervous system and of the skin among the patients than the controls (15 v 3 for central nervous system disease and 15 v 4 skin disease). There were also significantly fewer recordings of blood pressure and cervical cytology tests (34 v 51 for blood pressure and 2 v 18 for cytology). Although more patients were taking drugs affecting the central nervous system (33 v 6), more controls were taking drugs for musculoskeletal complaints (17 v 7). CONCLUSION: Although adult patients with learning disability consult with their general practitioners at equivalent rates to other patients, they get less preventive care and consult for different types of problems than do other patients. The reasons for these differences in preventive care are not clear. Carers and general practitioners should be informed of these differences to ensure that appropriate care is given.

Adult↗
PubMed1995

One-year follow-up of 89 infants with birth weights of 500 to 749 grams and respiratory distress syndrome randomized to two rescue doses of synthetic surfactant or air placebo. Canadian Exosurf Neonatal Study Group. Canadian Exosurf Neonatal Follow-Up Group.

Double-blind neurodevelopmental and physical evaluations were conducted at 1-year adjusted age in 89 infants with birth weights of 500 to 749 gm who had respiratory distress syndrome in the neonatal period and were randomized to receive two rescue doses of a synthetic surfactant (Exosurf Neonatal, Burroughs Wellcome Co., Research Triangle Park, N.C.) or air placebo. The trial used a common protocol and was conducted at 13 hospitals; patients were entered in the trial between February 1988 and September 1990. Ninety-five percent of surviving infants were assessed. Growth and development in the two groups were equivalent. Mean Bayley Scales of Infant Development scores were comparable (mental development index, 79 +/- 22 vs 87 +/- 20; psychomotor development index, 73 +/- 18 vs 81 +/- 19 for air placebo and synthetic surfactant, respectively). The incidence of severe retinopathy of prematurity was significantly decreased in the surfactant group compared with the air placebo group (15% vs 34%; relative risk 0.428; 95% confidence interval 0.2 to 0.9). Overall, administration of surfactant appeared to increase the probability of a favorable outcome. Confirmation of the trends observed in this study would provide a strong rationale for the rescue use of synthetic surfactant in extremely low birth weight infants with respiratory distress syndrome even if overall mortality is not reduced.

Air↗
PubMed1995

One-year outcome in 232 premature infants with birth weights of 750 to 1249 grams and respiratory distress syndrome randomized to rescue treatment with two doses of synthetic surfactant or air placebo. Canadian Exosurf Neonatal Study Group.

A randomized, double-blind, placebo-controlled trial was performed in 13 hospitals in Canada to assess whether two rescue doses of a synthetic surfactant (Exosurf Neonatal) would reduce mortality and morbidity rates in neonates with respiratory distress syndrome who weighed from 750 to 1249 gm. As part of the original trial design, double-blind follow-up evaluations were performed at 1-year adjusted age. A total of 118 patients who received air placebo and 114 patients who received synthetic surfactant were evaluated at 1 year. Growth and development in the two groups were equivalent. Scores on the Bayley Scales of Infant Development were within the normal range for both groups (mental development index, 90 +/- 22 vs 92 +/- 22; psychomotor development index, 81 +/- 19 vs 87 +/- 22 for the air placebo and synthetic surfactant groups, respectively). However, in both groups the proportion of infants with any impairment (air placebo group, 43 of 118 (36%); synthetic surfactant group, 41 of 114 (36%) and severe impairment (air placebo group, 29 of 118 (25%); synthetic surfactant group, 21 of 114 (18%)) was substantial. We conclude that two rescue doses of synthetic surfactant in infants with RDS who weighed 750 to 1249 gm had no detrimental effect on developmental outcome or late morbidity. No long-term benefits to 12-months corrected age were observed with the use of surfactant in this weight class. Larger studies or meta-analyses of existing trials will be required to determine if there are any late outcome advantages associated with rescue use of synthetic surfactant in infants weighing 700 to 1249 gm.

Air↗
PubMed1993

Why do patients change their general practitioner? A postal questionnaire study of patients in Avon.

The aim of this confidential postal questionnaire study was to determine why patients change their general practitioner. Among 1423 patients who changed their general practitioner without changing their address the reason most commonly given for leaving a general practitioner was distance (41%)--three quarters of these patients mentioned only distance. Just over one third of respondents (35%) mentioned dissatisfaction with the personal care given by the general practitioner and 36% mentioned dissatisfaction with practice organization. Specific patient requirements, such as a woman doctor, were not commonly mentioned. Convenience was the commonest reason given for choosing a new doctor (53%), with recommendation or reputation mentioned by 36% of respondents and positive expectations of service by 37%. The proportion of patients that changed from any one practice was small. This type of survey may prove a useful method for family health services authorities to identify practices with a higher than normal level of patient dissatisfaction.

Choice Behavior↗
PubMed1992

Measuring patient satisfaction: a test of construct validity.

OBJECTIVE: To establish the validity of two patient satisfaction questionnaires (surgery satisfaction questionnaire (SSQ) and consultation satisfaction questionnaire (CSQ)) developed for use in general practice. DESIGN: Prospective study of performance of SSQ and CSQ in patients selected for their predicted levels of satisfaction. SETTING: Avon Family Health Services Authority (FHSA); general practices in Bristol (practice A) and in Cheltenham (practice B). PATIENTS: 400 patients selected by Avon FHSA who had changed practices but not their home address and whose original practice had not changed its services (group 1); 869 randomly selected patients (221 from practice A, 648 from practice B) (group 2). MAIN MEASURES: Median difference in satisfaction scores for each questionnaire between groups 1 and 2 and between subgroups of group 2 patients according to assessed level in continuity of care (< 50%, > or = 50%) in the past 12 consultations. RESULTS: 272 (68.0%) patients in group 1 completed the SSQ and CSQ. 711 (81.2%) patients in group 2 (178/221 (80.5%) in practice A, 533/648(82.3%) in practice B) completed the SSQ and 374(88/106(83.0%), 286/335(85.4%)) completed the CSQ. Both questionnaires classified patients in groups 1 and 2 according to the construct of satisfaction; thus the difference in median scores for every component of satisfaction in each questionnaire was significant and occurred in the direction predicted by the construct. Each questionnaire also discriminated between patients grouped according to their assessed level of continuity of care. CONCLUSION: SSQ and CSQ are valid measures of satisfaction for these types of patients. IMPLICATIONS: Valid measures of patient satisfaction can be developed; untested instruments should no longer be used.

Adult↗
PubMed1991

Differences in the attitudes of men and women practitioners to responsibility and competence.

A study has been carried out to predict the prescribing and referral behaviour of general practitioners by measuring their attitudes to their roles. Part of this study involved determining whether women doctors accept greater responsibility and feel more competent than men when undertaking those tasks for which they are said to be suited. In May 1987 a postal questionnaire was sent to all 525 general practitioners in contract with Avon family practitioner committee. Replies from 82 women and 289 men showed that women accepted more responsibility for sex-related tasks. For other medical tasks, including those of a technical and traditional nature, men accepted both more responsibility and felt more competent than did women respondents. Contrary to expectations, women did not accept more responsibility or feel more competent than men for psychosocial tasks. The results are discussed in the context of the role of women within medicine.

Attitude of Health Personnel↗
PubMed1990

How to choose a new partner in general practice.

OBJECTIVE: To provide a guide to choosing a new partner in general practice by using psychometric assessments. DESIGN: A descriptive account of the experience of one practice. SETTING: A general practice in Bristol. RESULTS: The partners found that using a psychologist to assess both themselves and the candidates facilitated the selection process. During the pre-interview stage the partners learnt about the dynamics of the practice and their own personalities. The examination of the candidates by an outside assessor as well as the partners gave a sense of security and a certainty that mistakes were unlikely to be made. CONCLUSION: More practices should consider adopting a selection process using psychometric assessments when appointing a new partner.

England↗