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Biomedical subjects

P A Collier

Publications and source records attributed to P A Collier.

6 recordsLinked to original sources
PubMed2006

The impact of psoriasis guidelines on appropriateness of referral from primary to secondary care: a randomized controlled trial.

BACKGROUND: Most patients with psoriasis have limited disease which can be managed effectively in primary care. There is a marked variation in the frequency of referrals between practices reflecting, in part, inadequate training of general practitioners (GPs) in the management of psoriasis. OBJECTIVES: To assess the effectiveness of guidelines and training sessions on the management of psoriasis in reducing inappropriate referrals from primary care. METHODS: Patients aged 18 years or over with psoriasis were eligible for the cluster-randomized, randomized controlled trial if they were referred by their GP between 9 September 2002 and 31 December 2003 to one of four hospital dermatology departments in Greater Manchester, North-West England. All GPs from 165 health centres were invited to a lecture by a local dermatologist on the diagnosis and management of psoriasis. Health centres in the intervention arm received guidelines on the management of psoriasis in primary care, developed by local dermatologists, supplemented by the offer of a practice-based nurse-led training session; those in the control arm received neither guidelines nor training sessions. RESULTS: Eighty-two health centres were randomized to the intervention arm and 83 to the control arm. Outcome data were available for 188 of the 196 eligible patients referred during the study period. Patients in the intervention arm were significantly more likely to be appropriately referred in comparison with patients in the control arm [difference = 19.1%; odds ratio (OR) 2.47; 95% confidence interval (CI) 1.31-4.68; intracluster correlation coefficient (ICC) = 0]. Only 25 (30%) health centres in the intervention arm took up the offer of training sessions. There was no significant difference in outcome between health centres in the intervention arm that received a training session and those that did not (OR 1.28, 95% CI 0.50-3.29, ICC = 0). CONCLUSIONS: Dissemination of guidelines on the management of psoriasis in primary care can significantly enhance the appropriateness of referral of patients to secondary care.

Adolescent↗
PubMed1975

Attitudes toward death: a survey of nursing students.

The literature devoted to the topics of death and care of the dying is expanding rapidly. As nurses are inevitably involved in terminal illness, death and grief, their attitudes toward death and factors which affect these attitudes, are worthy of study. This report describes the results of a continuing two-year survey of one class of students in a baccalaureate nursing program. A questionnaire was used at the beginning and end of one academic year. Data were obtained regarding background experiences with death, involvement in the care of dying patients, and common ideas, concerns and feelings about death. Data from the second testing also included perceived changes in "positive" and "negative" attitudes toward death, and the relative effect on attitudes of various factors during the year. Suggestions are offered for curriculum development and research in the challenging area of death education in nursing.

Attitude to Death↗
PubMedDate not supplied

Distribution of neuronal heterotopiae following prenatal exposure to methylazoxymethanol.

The three-dimensional distribution of neuronal heterotopiae induced in rat brains by prenatal exposure to the cytotoxic drug, methylazoxymethanol acetate, has been examined by computer reconstruction techniques. Three types of heterotopiae may be identified in mature rat brains exposed between E11 and E16: Layer I heterotopiae, periventricular heterotopiae, and hippocampal heterotopiae. The distributions of Layer I heterotopiae and periventricular heterotopiae show clear temporospatial gradients; such that with subsequent age of exposure, Layer I heterotopiae are situated progressively more medially, dorsally, and rostrally, and periventricular heteotopiae are situated progressively more rostrally. Periventricular heterotopiae are most extensive following exposure to the agent on E14. For both of these heterotopiae there is a characteristic pattern of distribution for each gestational age of exposure to the agent. By contrast, hippocampal heterotopiae, consisting of misplaced pyramidal neurons in subfields CA1 and CA2 of Ammon's horn, did not show significant changes in distribution with different ages of exposure to the drug. The significance of these temporospatial gradients for mechanisms underlying the production of the heterotopiae is discussed.

Animals↗
PubMedDate not supplied

Mechanisms in the induction of neuronal heterotopiae following prenatal cytotoxic brain damage.

Prenatal exposure to several neuroteratogens, such as ionizing radiation, ethanol, and cytotoxic drugs, induces the development of clusters of abnormally positioned neurons within the brain. These abnormalities have always been presumed to result from interference with normal neuronal migration, presumably via effects on radial glia. In our study, pregnant rats were injected with methylazoxymethanol acetate (MAM) on either E13, E14, or E15. Computerised reconstruction techniques, Golgi and immunocytochemical staining as well as electron microscopy were used to detect structural abnormalities of radial glia which might be responsible for the production of heterotopiae. Several structural abnormalities such as microcavitation, involvement of radial glial elements in rosettes, disturbance of the normal ventricular lining, and disruption of the attachment of radial glial endfeet to the pial surface were identified. We propose that periventricular heterotopiae result from disruption of the palisade arrangement of neuroepithelial cells in the ventricular zone and the involvement of radial glial elements in rosettes. Layer I heterotopiae may arise from abnormalities of the distal segments of radial glia and their attachment to the pia. No prenatal abnormalities in radial glia of the hippocampus were noted following MAM exposure at any of the 3 ages, consistent with the proposition that hippocampal heterotopiae arise by postnatal movements of pyramidal neurons without radial glial involvement.

Animals↗
PubMedDate not supplied

A multicenter study of costs and nursing impact of cartridge-needle units.

A multicenter study of the overall costs and impact on medication administration of sterile cartridge-needle units (Carpuject) and conventional disposable syringes with multiple- and single-dose vials was conducted in six hospitals in the Voluntary Hospitals of America (VHA) system. Data collection involved a time and motion phase measuring procurement, preparation, and disposal of both systems and a 6-month prospective global cost analysis of component costs, waste disposal, nursing time, needlestick injuries, and subsequent treatment. Nonacquisition costs were substantially lower with the use of the cartridge-needle units. When all costs are considered, sterile cartridge-needle units are a cost-effective alternative to conventional disposable syringes and multidose vials.

Cost-Benefit Analysis↗