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P Jones

Publications and source records attributed to P Jones.

At least 73 records · Page 4Linked to original sources
PubMed2001

Caesarean section by choice could fulfil the inverse care law.

We have assessed knowledge about caesarean sections in a group of North Staffordshire Hospital professionals and patients. Those who were more interested in having a caesarean section without medical indication were the nulliparous health professionals, the majority of whom thought they should be able to choose this option. Paradoxically, this was also the group who were most likely to consider that caesarean section is more expensive and dangerous. The explanation may be that they also felt it to be an easier, less painful and more convenient option.

Attitude of Health Personnel↗
PubMed2001

Integrating baseline health status data collection into the process of care.

BACKGROUND: Health status data are an increasingly important component of outcomes assessment and can be used to facilitate quality assessment and improvement efforts. An enormous challenge to the use of health status data among hospitalized patients, however, is collecting baseline data at the time of treatment, an essential component for risk-adjusting subsequent outcomes. The Mid America Heart Institute of Saint Luke's Hospital (Kansas City, Mo), attempted to integrate the collection of health status assessments within the process of performing coronary revascularization. THE DATA COLLECTION STRATEGY: The data collection strategy was developed for each admission portalelective outpatients (admissions for same-day procedures), inpatients, and emergent cases. Health status data were collected on all patients with coronary artery disease who were receiving a percutaneous coronary intervention or coronary artery bypass graft with no disruption to physician scheduling or nursing staff. RESULTS: In general, patients were agreeable to completing the health status survey. Despite initial efforts to educate the hospital staff about the goal and purpose of health status assessment, staff members who were unaware of the uses of these data seemed to minimize their value. Providing examples of how to use these data relative to the staff member's specific occupational role facilitated buy-in for this project. EPILOGUE: After the pilot study, which lasted until June 1999, data were continually collected for 18 months, through August 2000, even with the cessation of external grant funding for this project. Baseline data collection finally stopped, primarily because of a failure to accommodate data collection into the routine flow of patient care by existing nursing staff.

Angioplasty, Balloon, Coronary↗
PubMed2001

Clinical trials update: Highlights of the Scientific Sessions of Heart Failure 2001, a meeting of the Working Group on Heart Failure of the European Society of Cardiology. CONTAK-CD, CHRISTMAS, OPTIME-CHF.

This article continues a series of reports summarising recent research developments pertinent to the topic of heart failure. This is a summary of presentations made at Scientific Sessions of Heart Failure 2001, a meeting of the Working Group on Heart Failure of the European Society of Cardiology. Clinical studies of particular interest to people caring for patients with heart failure include CONTAK-CD, CHRISTMAS and further updates on OPTIME-CHF. A brief review of the current status of cardiac resynchronisation therapy is included.

Cardiology↗
PubMed2001

Maternal antecedents for cerebral palsy in extremely preterm babies: a case-control study.

The study aimed to identify significant antenatal risk factors for cerebral palsy (CP) among extremely preterm infants with a matched case-control design. Infants born between 1989 and 1996 at 24 to 27 weeks' gestation who survived to hospital discharge were evaluated: 30 with a proven diagnosis of CP at 2 years corrected for prematurity and 120 control children matched for gestational age without CP. Information on maternal obstetric risk factors and medication was obtained. Matched analyses were performed and odds ratios (OR) and 95% confidence intervals (CI) were calculated. An antenatal diagnosis of intrauterine growth restriction was associated with an increased risk of CP (OR 6.6; 95% CI 1.8 to 25.2), while maternal administration of corticosteroids was associated with a reduced risk of CP (OR 0.4; 95% CI 0.1 to 0.98). A high rate of placental histopathology was achieved but no relation between clinical or histological chorioamnionitis or funisitis and CP was demonstrated. Maternal preeclampsia was not associated with a statistically significant reduction in the risk of CP. It is concluded that a reduced risk of CP in extremely preterm infants is associated with the antenatal use of corticosteroids.

Adrenal Cortex Hormones↗
PubMed2001

Verbal fluency in patients with schizophrenia and affective psychoses and their first-degree relatives.

BACKGROUND: Schizophrenic patients are known to have neuropsychological deficits including impaired verbal fluency, but it is not clear whether this latter deficit is: (a) a consequence of overall intellectual deficit; (b) shared with affective psychotic patients; or (c) shared by the relatives of schizophrenic patients; and (d) shared by the relatives of affective psychotic patients. METHODS: We administered Thurstone's Verbal Fluency Test to 45 schizophrenic patients and 72 of their relatives, and 30 affective psychotic patients and 53 of their relatives. Subjects were asked to generate as many words as possible beginning with the letters 'C' and 'S' and the total was taken as the dependent variable. Subjects also completed the National Adult Reading Test (NART) to provide a measure of (pre-morbid) IQ. RESULTS: Schizophrenic patients generated significantly fewer words than affective psychotic patients, however adjusting for NART this became non-significant. Schizophrenic (but not affective psychotic) patients generated significantly fewer words than their relatives; again adjusting for NART this became non-significant. Patients who had been exposed to obstetric complications (OC+) and those who had not (OC-) had similarly poor verbal fluency scores. Relatives of OC+ schizophrenic patients had superior verbal fluency than relatives of OC- schizophrenic patients and this remained significant after adjustment for NART. CONCLUSIONS: The results suggest that some families transmit impairment in verbal fluency as part of a pattern of lower overall IQ. However, in other families, relatives show largely normal neuropsychological function, and the poorer verbal performance of the schizophrenic member appears to have arisen secondary to his/her exposure to OCs.

Adult↗
PubMed2001

The potential use of the South African river crab, Potamonautes warreni, as a bioindicator species for heavy metal contamination.

In 1995, preliminary water and sediment analyses of the river bed and burrow sediments from 9 locations along the Mooi River, NW Province, South Africa had shown cadmium concentrations up to 0.009 mg l-1 +/- 0.003 and up to 0.33 and 0.89 weight % with scanning electron microscopy (SEM) and x-ray microanalysis. Samples of the adult river crab (Potamonautes warreni) were collected from the Mooi River at Noordbrug (26 degrees 40'S/27 degrees 05'E), 1 km north of Potchefstroom Town, and exposed to 0.2 or 2.0 mg Cd2+ l-1 in situ to determine tolerance, uptake and bioaccumulation of cadmium. Using flame atomic absorption spectroscopy (FAAS) the gills, haemolymph and digestive gland of naturally exposed P. warreni showed wet mass values of 0.74 +/- 0.27 microgram Cd2+ g-1, 0.007 +/- 0.007 microgram ml-1 and 0.12 +/- 0.09 microgram g-1 respectively. The tolerance of crabs to aqueous Cd reached its limit (ET50 = 42 hours) at 2.0 mg l-1 aqueous Cd exposure. At an exposure to 0.2 mg Cd2+ l-1 for 21 days, the greatest Cd (n = 11; 9.99 +/- 5.09 micrograms g-1 wet mass) and Cu concentrations (n = 11; 17.90 +/- 4.66 micrograms g-1 wet mass) were associated with the gills, and to a lesser extent the digestive gland (n = 11; 0.38 +/- 0.20 microgram g-1 wet mass), whereas concentrations of Zn were variable in both organs. In the haemolymph Cd levels were relatively small (n = 11; 0.012-0.006 microgram ml-1) with exposure and time and Cu, Zn concentrations varied. Changes in the uptake of Cd in P. warreni indicated that transport, storage and possibly regulatory mechanisms are likely to operate in adult crabs. The potential of P. warreni as a bioindicator species of pollution is also discussed.

Animals↗
PubMed2001

Birth order and risk for schizophrenia: a 31-year follow-up of the Northern Finland 1966 Birth Cohort.

OBJECTIVE: The Northern Finland 1966 Birth Cohort was studied in order to investigate the association between birth order and schizophrenia. METHOD: Four categories of birth order status (first-born, last-born, only child and other status) were formed and linked to data on psychiatric morbidity. Effects were adjusted for wantedness of pregnancy, perinatal complications, maternal age at delivery, family type and number of siblings. RESULTS: The risk for schizophrenia was elevated among male first-borns (ratio 1.5; 95% CI 1.0-2.2) and female last-borns (ratio 1.3; 95% CI 0.9-1.9). The risk was lower than expected among male last-borns (ratio 0.7; 95% CI 0.5-0.9) and females belonging to other status (ratio 0.6; 95% CI 0.3-0.9). CONCLUSION: These results suggest that specific birth order status is an independent risk factor for schizophrenia. Theoretical explanations may arise from biological factors unidentified here and/or psychological stressors linked with these positions.

Adult↗
PubMed2001

Interaction of stilbene disulphonates with cloned K(ATP) channels.

In this study, we tested the effects of the stilbene disulphonates DIDS and SITS on three different types of cloned K(ATP) channel (Kir6.2/SUR1, Kir6.2/SUR2A and Kir6.2DeltaC) heterologously expressed in Xenopus oocytes, with the aim of identifying the part of the channel which is involved in mediating disulphonate inhibition. We found that the inhibitory site(s) for these drugs lies within the Kir6.2 subunit of the channel, although its properties are further modulated by the sulphonylurea (SUR) subunit. In particular, SUR2A reduces both the rate and extent of block, by impairing the ability of DIDS binding to produce channel closure. The disulphonate-binding site interacts with the ATP inhibitory site on Kir6.2 because ATP is able to protect against irreversible channel inhibition by disulphonates. This effect is not mimicked by tolbutamide (at a concentration that interacts with Kir6.2) and is abolished by mutations that render the channel ATP insensitive. A number of point mutations in both the N and C termini of Kir6.2 reduced the extent and reversibility of channel inhibition by SITS. The results are consistent with the idea that residue C42 of Kir6.2 is likely to be involved in covalently linking of SITS to the channel. Other types of Kir channel (Kir1.1, Kir2.1 and Kir4.1) were also irreversibly blocked by DIDS, suggesting that these channels may share common binding sites for these stilbene disulphonates.

4,4'-Diisothiocyanostilbene-2,2'-Disulfonic Acid↗
PubMed2001

Mutations within the P-loop of Kir6.2 modulate the intraburst kinetics of the ATP-sensitive potassium channel.

The ATP-sensitive potassium (K(ATP)) channel exhibits spontaneous bursts of rapid openings, which are separated by long closed intervals. Previous studies have shown that mutations at the internal mouth of the pore-forming (Kir6.2) subunit of this channel affect the burst duration and the long interburst closings, but do not alter the fast intraburst kinetics. In this study, we have investigated the nature of the intraburst kinetics by using recombinant Kir6.2/SUR1 K(ATP) channels heterologously expressed in Xenopus oocytes. Single-channel currents were studied in inside-out membrane patches. Mutations within the pore loop of Kir6.2 (V127T, G135F, and M137C) dramatically affected the mean open time (tau(o)) and the short closed time (tauC1) within a burst, and the number of openings per burst, but did not alter the burst duration, the interburst closed time, or the channel open probability. Thus, the V127T and M137C mutations produced longer tau(o), shorter tauC1, and fewer openings per burst, whereas the G135F mutation had the opposite effect. All three mutations also reduced the single-channel conductance: from 70 pS for the wild-type channel to 62 pS (G135F), 50 pS (M137C), and 38 pS (V127T). These results are consistent with the idea that the K(ATP) channel possesses a gate that governs the intraburst kinetics, which lies close to the selectivity filter. This gate appears to be able to operate independently of that which regulates the long interburst closings.

Adenosine Triphosphate↗
PubMed2001

The dimensions of service quality for hospitals: development and use of the KQCAH scale.

Using a combination of qualitative and quantitative research methodologies, this study identifies the dimensions of hospital service quality, operationalizes the dimensions, and develops an instrument to measure patient satisfaction. This instrument, the Key Quality Characteristics Assessment for Hospitals (KQCAH) scale, was developed using input from 12 hospital administrators, over 100 hospital employees, and 23 recent patients and family members.

Attitude of Health Personnel↗
PubMed2001

A comparative study of feature-salience ranking techniques.

We assess the relative merits of a number of techniques designed to determine the relative salience of the elements of a feature set with respect to their ability to predict a category outcome-for example, which features of a character contribute most to accurate character recognition. A number of different neural-net-based techniques have been proposed (by us and others) in addition to a standard statistical technique, and we add a technique based on inductively generated decision trees. The salience of the features that compose a proposed set is an important problem to solve efficiently and effectively, not only for neural computing technology but also in order to provide a sound basis for any attempt to design an optimal computational system. The focus of this study is the efficiency and the effectiveness with which high-salience subsets of features can be identified in the context of ill-understood and potentially noisy real-world data. Our two simple approaches, weight clamping using a neural network and feature ranking using a decision tree, generally provide a good, consistent ordering of features. In addition, linear correlation often works well.

Accidents, Aviation↗
PubMed2001

Reduction of LDL cholesterol in patients with primary hypercholesterolemia by SCH 48461: results of a multicenter dose-ranging study.

SCH 48461, an inhibitor of gastrointestinal absorption of cholesterol, was evaluated for its effects on lipid parameters in patients with primary hypercholesterolemia in a multicenter, double-blind, randomized, parallel-group study. Following the baseline phase, which consisted of a 2- to 10-week drug washout and dietary stabilization phase and a 4-week placebo lead-in (placebo baseline phase), 190 patients were randomized to an 8-week double-blind active drug (SCH 48461 1, 6.25, 25, 100, 200, or 400 mg) or 40 mg lovastatin once daily each morning or placebo treatment phase. By week 2, patients who received SCH 48461 6.25 to 400 mg or lovastatin demonstrated greater reduction from baseline in directly measured low-density lipoprotein cholesterol (LDL-C) levels than patients in the placebo group (p < or = 0.03). Overall, the percent reductions in LDL-C from baseline increased as the dose of SCH 48461 increased, with 0.6% to 15.5% reductions from the minimum dose of 1 mg to the maximum dose of 400 mg. Lovastatin 40 mg/day reduced LDL-C by 30.7% (p < 0.01). Statistically significant decreases were also seen for total cholesterol and apolipoprotein B (apo B) with doses of 25 mg to 400 mg of SCH 48461 and lovastatin. SCH 48461 was well tolerated. There was a similar incidence of adverse events in each SCH 48461- or lovastatin-treated group compared to placebo. This study demonstrated a clinically and statistically significant cholesterol-lowering effect of SCH 48461 in patients with primary hypercholesterolemia.

Anticholesteremic Agents↗
PubMed2001

Reducing risk by improving standards of intrapartum fetal care.

Confidential Enquiries into Stillbirths and Deaths in Infancy (CESDI) have pointed to a high frequency of suboptimal intrapartum fetal care of a kind that, in the event of an adverse outcome, is hard to defend in court. In an effort to minimize liability, various strategies were applied in a district hospital labour ward--guidelines, cyclical audit, monthly feedback meetings and training sessions in cardiotocography (CTG). The effects of these interventions on quality of care was assessed by use of the CESDI system in all babies born with an Apgar score of 4 or less at 1 min and/or 7 or less at 5 min. 540 babies (4.3%) had low Apgar scores, and neither the percentage nor gestational age differed significantly between audit periods. In the baseline audit, care was judged suboptimal (grade II/III) in 14 (74%) of 19 cases, and in the next four periods it was 23%, 27%, 27% and 32%. In the latest audit period, after further educational interventions, it was 9%. Many of the failures to recognize or act on abnormal events were related to CTG interpretation. After the interventions there was a significant increase in cord blood pH measurement. There were no differences between audit periods in the proportion of babies with cord pH < 7.2. These results indicate that substantial improvements in quality of intrapartum care can be achieved by a programme of clinical risk management.

Apgar Score↗
PubMed2001

Aggressive incidents in first-episode psychosis.

BACKGROUND: Recent research has reported increased risk of aggressive incidents by individuals with psychotic illness. AIMS: To examine acts of aggression in first-episode psychosis. METHOD: Subjects with a first-episode psychosis were ascertained from a defined catchment area (Nottingham, UK) and reassessed at 3 years (n=166) using clinical interview, informants, health care and forensic records. RESULTS: Of the subjects, 9.6% demonstrated at least one act of serious aggression (defined as weapon use, sexual assault or victim injury) during at least one psychotic episode and 23.5% demonstrated lesser acts of aggression (defined as all other acts of aggression). For all aggressive subjects (33.1%), unemployment (OR=3.6, 95% C11.6-8.0), comorbid substance misuse (OR=3.1, C1 1.1-8.8) and symptoms of overactivity at service contact (OR=6.9,C1 2.7-17.8) had independent effects on risk of aggression. CONCLUSIONS: We confirmed some previously reported demographic and clinical associations with aggression in first-episode psychosis but no relationship with specific psychotic symptoms or diagnostic groups was observed.

Adolescent↗
PubMed2001

Specificity of the Oxford knee status questionnaire. The effect of disease of the hip or lumbar spine on patients' perception of knee disability.

There is a need for the accurate measurement of the outcome after knee surgery. The Oxford Knee Score is being increasingly used since it is reported to be short, simple, inexpensive and validated. We sent the questionnaire to 346 patients awaiting surgery to the hip or lumbar spine. Only 11% of 141 patients with proximal pathology who denied knee problems gave a maximum score. Their mean score was substantially lower than expected at 28.7 (maximum 48), and was significantly lower than the score of 36.5 obtained from patients after total knee replacement. We therefore suggest that the frequent coexistence of hip or spinal pathology will significantly alter both the absolute score and any improvement to be expected after knee surgery. Although sensitive to disability originating from the knee the Oxford Knee Score is not sufficiently specific since it is heavily influenced by more proximal pathology.

Hip↗