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Biomedical subjects

R Jones

Publications and source records attributed to R Jones.

At least 379 records · Page 21Linked to original sources
PubMed1997

Mental health care training priorities in general practice.

BACKGROUND: Mental health problems constitute a large part of general practitioners' (GPs') work, for which they may have received little training beyond their undergraduate education. They continue to find themselves criticized in the literature over inadequate recognition and management of these problems. While there is concern about the effectiveness of continuing medical education (CME), educational needs assessment can improve the outcome of CME programmes. AIM: To assess GPs' perceived educational needs regarding mental health problems. METHODS: A questionnaire was developed, piloted and posted to GPs (n = 380) in the Lambeth, Southwark and Lewisham Family Health Services Authority (FHSA) area in south-east Thames. In addition to demographic data, the questionnaire asked practitioners to select from a list of 26 mental health topics those in which they would like further training, their preferred educational formats and timetabling, and willingness to attend for training. Two postal reminders were sent to non-respondents. Data were analysed using SPSS. RESULTS: Altogether, 62% (237/380) of the GPs responded. The range for the number of topics selected was from zero to 26 and the mode was 5. Most frequently selected topics were psychiatric emergencies, somatization, counselling skills, 'heartsink' patients, psychosexual problems and stress management, each of which was chosen by at least 40%. Small group work alone, and allied to a lecture, was rated as the most useful educational format. In all, 74% (175/237) indicated that they would be interested in attending a half-day training course. CONCLUSION: These results suggest that GPs working in the inner city recognize the importance of improving their skills in the care of mental health problems, and indicate which topics are regarded as the most important and suitable for educational interventions. A needs-led approach to continuing medical education of this kind will help to plan CME programmes relevant to GPs' needs.

Adult↗
PubMed1997

Army family practice: does our training meet our needs?

OBJECTIVES: (1) To determine the perceived adequacy of residency training for current practice by Army family physicians; (2) to ascertain if differences exist by residency setting: medical center, medical activity, or civilian. METHODS: Surveys were mailed to the 334 family physicians in the Army in 1993. Training in various subject areas was rated as inadequate, adequate, or overly prepared. RESULTS: More than 75% of respondents felt prepared in 76% of general medical subjects (GM) but in only 39% of family medicine subjects (FM). There were no practice management subjects in which more than 75% felt adequately prepared. There were no differences in perceptions of GM or FM training between military- and civilian-trained respondents. CONCLUSIONS: Army and civilian residencies prepare family physicians for the medical aspects of practice. Early training in management subjects could be enhanced. Civilian and Army programs could improve training in family medicine subjects.

Analysis of Variance↗
PubMed1997

Tissue distribution of ketamine in a mixed drug fatality.

While reports of ketamine abuse are increasing, reports of ketamine deaths and tissue concentrations associated with fatalities are rare. We report here a case of a mixed drug fatality involving ketamine and ethanol. Ketamine analysis was carried out by gas chromatography with a nitrogen-phosphorus detector (NPD). We found the following tissue concentrations: blood 1.8 mg/L; urine 2.0 mg/L; brain 4.3 mg/kg; spleen 6.1 mg/kg; liver 4.9 mg/kg, and kidney 3.6 mg/kg. The blood ethanol concentration was 170 mg/dL. Because an empty nalbuphine ampule was found in the possession of the deceased, the blood was assayed for this opioid compound using a gas chromatography/mass spectrometry (GC/MS) method. None was detected at a limit of detection of 0.02 mg/L.

Adult↗
PubMed1997

Emotional distress and morbidity in dementia carers: a matched comparison of husbands and wives.

OBJECTIVE: This study aimed to: (i) replicate previous findings that women experience more strain and distress than men when caring for dementing spouses; (ii) explore what factors underlie this sex difference. DESIGN: Two closely matched subsamples of spouse carers, husbands and wives respectively, were selected and the two groups compared. SETTING: An urban psychogeriatric service in the UK. SUBJECTS: 48 spouses of referred dementia cases. MEASURES: Mental health was rated by the General Health Questionnaire, the Strain Scale and the Life Satisfaction Index. Various factors related to caregiving were assessed by the Problem Checklist, and a specially devised instrument to record caregiving task involvement, formal/informal support, objective burden, satisfaction with supports and attitudes to the relationship and to caregiving. RESULTS: The wives' levels of strain and morale were significantly worse than husbands'. There were qualitative differences between husbands and wives in terms of caregiving tasks undertaken. Wives tolerated dementia sufferers depending on them less well. Wives were also more likely to wish to leave caregiving to someone else and cited more reasons for giving up. Subjects of both sexes displayed a strong tendency to view women as generally better suited to the caregiving role, and wives felt a greater obligation to care. CONCLUSIONS: It is concluded that such attitudinal or social factors are the chief determinants of wives' higher levels of strain and distress.

Aged↗
PubMed1997

How can adolescents' health needs and concerns best be met?

BACKGROUND: A previous survey of letters to 'agony aunts' revealed that adolescents have many concerns about their health. AIM: To discover the views of adolescents on a range of issues including the venues where they would like to be seen, the doctors they would like to consult, and the subjects they would like to discuss. METHOD: A questionnaire was distributed to adolescents in a variety of school settings and distributed through a popular teenage magazine. RESULTS: A total of 525 replies were received. Most adolescents had visited their general practitioner (GP) in the previous year. Most would prefer to see a teenage health specialist at a venue other than their local surgery, and to have the option of a 'drop-in' service. Responders were worried about a wide range of health issues. They had strong opinions on the type of doctor they would like to consult and the style of surgery they would prefer. Concerns were expressed about confidentiality. CONCLUSION: In the short term, surgeries could be made more 'user-friendly' for adolescents. In the longer term, the authors propose liaison between GPs and paediatricians with a special interest in teenage health to provide a confidential, combined youth service, with ideas on service development based on the expressed wishes of the adolescent population.

Adolescent↗
PubMed1996

Chlamydia trachomatis major outer membrane protein (MOMP) epitopes that activate HLA class II-restricted T cells from infected humans.

We localized peptide epitopes within the Chlamydia trachomatis (Ct) major outer membrane protein (MOMP) that activate human T cells. T-MOMP' cells were prepared by culturing PBL from 38 humans who had Ct infections in the presence of Ct serovar E MOMP. Some epitopes were first localized by quantifying proliferative responses of T-MOMP' cells to overlapping MOMP segments (sixths) that were produced in Escherichia coli. Further localization was achieved by using overlapping synthetic 16-22 mers that spanned stimulatory MOMP sixths as Ags. The APCs used were human B cell lines (LCL) that were matched or mismatched with respect to HLA class II alleles of the T-MOMP' cells. T cell epitopes were detected in 18 Ct serovar E MOMP 16-22 mers and were presented in association with HLA-DR1, -7, -13, -17, HLA-DRw52, HLA-DQ3 and at least two from among HLA-DR4, -8, -11, -14, -18, in probable addition to HLA-DP4. Peptide 249-265 stimulated T-MOMP' cells from 83% of the subjects; studies with overlapping 11-13 mers spanning peptide 249-265 revealed at least six epitopes presented with different HLA-class II allotypes. Diverse T-MOMP' cultures responded to between 2 and 7 MOMP epitopes. All but 1 of the 23 epitopes localized to date are distributed among four MOMP constant segments. T-MOMP' cells from subjects infected with serovars other than E also responded.

Alleles↗
PubMed1996

Paired comparison of vascular wall reactions to Palmaz stents, Strecker tantalum stents, and Wallstents in canine iliac and femoral arteries.

BACKGROUND: Palmaz stents, Strecker stents, and Wallstents, all used clinically, differ substantially in their physical characteristics, yet how differently the vascular wall reacts to them has not been demonstrated conclusively. We therefore undertook a side-by-side comparison. METHODS AND RESULTS: One stent was implanted into each canine external iliac and/or the flexing portion of the proximal femoral artery. In 9 dogs, Palmaz stents were placed vis-à-vis Strecker stents, with follow-up of 2 and 4 months. In 7 dogs, Palmaz stents were placed vis-à-vis Wallstents, with 4 months of follow-up. Angiographic midstent luminal diameters immediately after placement and at follow-up as well as midstent cross-sectional areas of neointima were compared for significant differences. In addition, neointimal maturation, medial atrophy, and stent-related trauma were assessed. Angiographically, all arteries remained open. The degree of luminal narrowing by recoil and neointima never reached 50% and was modest for Palmaz stents and Wallstents (P = .33) but significantly higher for Strecker stents (P < .0001 compared with Palmaz stents). This corresponded histologically to a significantly thicker neointima (P = .003) over Strecker than over Palmaz stents but not between Palmaz stents and Wallstents (P = .18). Neointimal buildup was generally more pronounced in the femoral artery segments than in the iliac segments. Maturation of the neointima over Palmaz stents was much further advanced than over Strecker stents and slightly more advanced than over Wallstents. Pressure-related atrophy of the tunica media was least for Strecker stents and more pronounced but similar for Wallstents and Palmaz stents. Wallstent wire ends caused some wall trauma; several femoral Palmaz stent struts protruded through the media. CONCLUSIONS: The lower-hoop-strength, higher-profile tantalum Strecker stent is affected by vascular wall recoil and evokes a greater degree of neointima formation than the lower-profile, higher-hoop-strength Palmaz stent and Wallstent. Medial atrophy is pronounced outside the latter two stents. The rigid Palmaz stent can penetrate through the vascular wall in flexing arteries.

Animals↗
PubMed1996

A study of general practitioners' reasons for changing their prescribing behaviour.

OBJECTIVES: To explore general practitioners' reasons for recent changes in their prescribing behaviour. DESIGN: Qualitative analysis of semistructured interviews. SETTING: General practice in south east London. SUBJECTS: A heterogeneous sample of 18 general practitioners. RESULTS: Interviewees were able to identify between two and five specific changes that had occurred in their prescribing in the preceding six months. The most frequently mentioned changes related to fluoxetine, angiotensin converting enzyme inhibitors, and the antibiotic treatment of Helicobacter pylori. Three models of change were identified: an accumulation model, in which the volume and authority of evidence were important; a challenge model, in which behaviour change followed a dramatic or conflictual clinical event; and a continuity model, in which change took place against a background of willingness to change, modulated by other factors such as cost pressures and the comprehensible therapeutic action of a drug. Behaviour change was reinforced and sustained by experiences with individual patients. CONCLUSIONS: Multiple factors are involved in general practitioners' decisions to change their prescribing habits. Three models of change can be identified which have important implications for the design and evaluation of interventions aimed at behaviour change.

Adult↗