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Biomedical subjects

Richard Baker

Publications and source records attributed to Richard Baker.

At least 55 records · Page 3Linked to original sources
PubMed2003

Randomised controlled trial of the effectiveness of feedback in improving test ordering in general practice.

OBJECTIVE: To assess the effectiveness of feedback on the number of pathology tests ordered by general practices. DESIGN: Randomised controlled trial. SETTING: General practices in two primary care groups in Leicestershire, UK. SUBJECTS: 58 general practitioners in 17 practices received guidelines then feedback at 3-month intervals for 1 year about the numbers of thyroid function, rheumatoid factor tests and urine cultures they ordered, and 38 general practitioners in 16 practices received guidelines then feedback about lipid and plasma viscosity tests. MAIN OUTCOME MEASURES: Numbers of tests requested per thousand patients registered with each practice. RESULTS; There were no changes in the numbers of tests per thousand requested in either of the study groups for any of the tests. CONCLUSIONS: Feedback did not have an influence on test ordering by general practitioners in this study. More intensive strategies may be required to change the use of laboratory tests.

Diagnostic Tests, Routine↗
PubMed2003

Exploration of the relationship between continuity, trust in regular doctors and patient satisfaction with consultations with family doctors.

OBJECTIVE: To determine the influence of longitudinal continuity and trust in patients' regular family doctors on patient satisfaction with consultations. DESIGN: Observational questionnaire study. SETTING: Three family practice centres in the USA and four general practices in the UK. SUBJECTS: 418 patients in the USA and 650 in the UK who were consulting family doctors. MAIN OUTCOME MEASURES: A pre-consultation questionnaire sought information about the patient's experience of continuity and trust in their regular doctor; a post-consultation questionnaire measured satisfaction with the consultation. RESULTS: 78.8% of patients rated seeing the same doctor every time they had a health problem as important or very important. Trust in the regular doctor, consulting the regular doctor and country were the strongest predictors of satisfaction. Patients who had a high level of trust in their regular doctor and consulted that doctor had the highest levels of satisfaction with their consultations. Among patients with relatively low levels of trust in regular doctor, levels of satisfaction were similar whether or not they consulted their regular doctor. CONCLUSIONS: Consulting the regular doctor, trust and satisfaction with consultations are associated, and patients who consult a doctor they trust report the highest levels of satisfaction with consultations.

Adult↗
PubMed2003

Prevalence and management of inflammatory bowel disease: a cross-sectional study from central England.

OBJECTIVES: To estimate the prevalence of inflammatory bowel disease (IBD) from the information in general practitioners' records and to describe patient management, including the prescribing of 5-aminosalicylates and adherance to treatment in ulcerative colitis, and frequency of advice given concerning cessation of smoking. METHODS: Fifteen general practices were recruited through the Trent Focus Collaborative Research Network, UK, to take part in a cross-sectional study. They identified confirmed cases of IBD and used a pro-forma to collect data for collation and analysis. RESULTS: Searches identified 344 IBD cases from a combined list of 86 801 patients, suggesting a prevalence of 396 per 100 000 (95% confidence interval, 356-440). Practices considered 32% of patients to be under the sole care of general practitioners; only 59% had been seen in secondary care during the previous year and the numbers of outpatient and general practitioner consultations were similar. Smoking cessation advice was documented for similar numbers of smokers with Crohn's disease and ulcerative colitis. Excluding patients who had undergone surgery, only 65% of patients with ulcerative colitis had been prescribed a 5-aminosalicylate in the previous 6 months and good treatment adherence was suggested in only 42% of ulcerative colitis patients taking a 5-aminosalicylate. Prescribing of aminosalicylates was more common in patients under specialist or shared care than those under general practitioner care only; this remained significant in a regression model also including extent of disease (P < 0.0001). CONCLUSIONS: General practitioners play an important role in caring for patients with IBD and may need relevant education and support. Aminosalicylates appear to be under-used in patients with ulcerative colitis.

Adult↗
PubMed2003

Identifying a region of interest in site- and stage-specific colon cancer on chromosome 13.

BACKGROUND: The role of genes on chromosome 13q has not been confirmed in colorectal tumors, in part because most series that have been studied are heterogeneous in terms of tumor site, stage, and replication error (RER) status. Using a highly homogenous series of colon tumors, our aim was to identify areas of interest on 13q that are important in carcinogenesis. METHODS: Twenty-three RER-negative tumor specimens from patients with right-sided Dukes' stage C colon tumors were selected for analysis with 10 microsatellite markers spanning 13q. The polymerase chain reaction-amplified products were analyzed by using a standard fluorescent loss of heterozygosity/allele imbalance assay. RESULTS: Markers showing the highest frequency of allelic imbalance were as follows: D13S175 (31%), D13S289 (27%), D13S263 (25%), and D13S265 (27%). The overall resolution of the map was approximately 11.4 to 11.7 cM. CONCLUSIONS: This study of right-sided, RER-negative, Dukes' stage C colon tumors showed the highest area of allelic imbalance corresponding to 13q11.2-11. This region includes LATS2 (large tumor suppressor 2 gene) and FGF9 (fibroblast growth factor 9), which may be involved in carcinogenesis.

Alleles↗
PubMed2003

Patient involvement in general practice care: a pragmatic framework.

This paper presents a pragmatic framework to guide decisions on involving people in general practice care. Patient involvement may be defined as: enabling patients to take an active role in deciding about and planning their healthcare. It can be located at different levels of care, including the patient-clinician contact or episode of care, and the patient population served by a care provider, or the regional or national population. The involvement of patients depends on considerations that include the aim of patient involvement, the type of health decision, and the type of patient. With respect to the aims, the fundamental question is whether involvement is seen as desirable in itself, or whether it is expected to result in favourable consequences. We suggest that patients' ability and willingness to be involved should determine the level of involvement. The concept of involving patients is relatively new, and new approaches are required to overcome obstacles for its implementation in healthcare.

Family Practice↗
PubMed2003

Randomised controlled trial of the impact of guidelines, prioritized review criteria and feedback on implementation of recommendations for angina and asthma.

BACKGROUND: Guidelines are frequently used in an attempt to influence the performance of health professionals, and a national agency has been established in England and Wales to develop and disseminate guidelines. Professionals prefer short guidelines that highlight key recommendations, but whether such guidelines are more likely to be implemented is unknown. AIM: To determine the relative impact of the dissemination of full guidelines, reduced guidelines in the form of prioritized review criteria, and review criteria supplemented by feedback. DESIGN OF STUDY: Cluster randomised controlled trial, with an incomplete block design. SETTING: Eighty-one general practices in Leicestershire, Lincolnshire, Northamptonshire, North Derbyshire, and Nottinghamshire. METHOD: The practices received one of the study interventions, either for care of adults with asthma or for care of people with angina. Data were collected before and after the interventions, the process measures being adherence to ten recommendations about asthma and 14 about angina, and outcome measures being scores in response to an asthma symptom questionnaire or the Seattle Angina Questionnaire, and levels of patient satisfaction. RESULTS: There were no consistent differences between the interventions in stimulating improvements in performance as indicated by adherence to the recommendations for asthma or angina. Patients with angina in practices that had received criteria or criteria plus feedback reported better symptom control. CONCLUSION: The dissemination of guidelines in the format of prioritized review criteria does not increase adherence to recommendations in comparison with the traditional guideline format, and the further provision of feedback has minimal additional effect.

Aged↗
PubMed2003

Factors associated with patients' trust in their general practitioner: a cross-sectional survey.

This study aimed to identify factors that are associated with patients' overall trust in their general practitioner (GP). A survey of patients in ten general practices in the East Midlands was conducted. Most patients (76%) reported high levels of trust in their GP. Regression analysis showed that measures of the quality of the GP-patient relationship (GP-patient communication, interpersonal care, and knowledge of the patient) were strongly associated with trust in a patient's usual GP, whereas patients' reports of duration of registration with the practice, and proportion of visits to the usual GP were not.

Adolescent↗
PubMed2002

Estimating mechanical cost in subjects with myelomeningocele.

An attempt was made to validate a system of calculating mechanical cost using 3-D motion analysis by using Oxygen cost measurements in 26 subjects with myelomeningocele. The three models investigated were (i) vertical excursion of the centre of mass (model 1), (ii) external work done by the centre of mass (CM) (model 2) and (iii) a full body model allowing energy transfers between segments within limbs (model 3). Oxygen cost, and models 1 and 3 all demonstrated significant differences between S1 and L4/L5 level involvement (P=0.001, 0.002 and 0.01, respectively). No significant differences were observed between subjects who had L4 and L5 level involvement. While further analysis showed a moderate correlation between Oxygen cost and the vertical excursion of CM model (R2=0.60), a lack of correlation for the more sophisticated models 2 and 3 questions their use as a method of assessing the energy cost of locomotion in this population.

Adolescent↗
PubMed2002

Heart failure in primary care: qualitative study of current management and perceived obstacles to evidence-based diagnosis and management by general practitioners.

BACKGROUND: Chronic heart failure is a common clinical condition with high morbidity and mortality. Despite the evidence that appropriate treatment with angiotensin-converting enzyme inhibitors can improve morbidity, primary care studies show that patients with heart failure are incorrectly diagnosed and inadequately treated. AIM: To explore general practitioners' accounts of their management of patients with heart failure and identify the perceived obstacles to diagnosis and management. METHODS: We conducted this qualitative study using semi-structured interviews in 18 general practices. The practices were stratified on the basis of size, location, and the level of practice development. The interviews were based on a schedule of open questions based on the literature on diagnosis and management of patients with heart failure. Transcriptions of the audiotaped interviews were independently analysed by two researchers and analysis was based on open coding using a constant comparative approach. Categories were reduced to major themes. RESULTS: General practitioners suspect heart failure when patients present with breathlessness or ankle oedema. Many general practitioners reported that they would diagnose heart failure after respiratory examination and a positive finding of basal crepitations. Many general practitioners arrange a chest X-ray to establish the diagnosis and some arrange an electrocardiogram. A few general practitioners mentioned that they diagnosed heart failure with a trial of diuretics. Obstacles to diagnosis were mentioned by most general practitioners and included lack of facilities for appropriate investigations (especially echocardiography) and lack of time and expertise. Obstacles to management included lack of time, high cost of drugs, difficulty with diagnosis, selection bias towards younger patients and not having the confidence to initiate angiotensin-converting enzyme inhibitors. Many general practitioners were unaware of the impact angiotensin-converting enzyme inhibitors can have on morbidity and mortality. CONCLUSIONS: Although symptoms of heart failure are not sufficiently specific for diagnosing patients with heart failure, many general practitioners in European countries treat people with suspected heart failure on the basis of symptoms and signs alone. This study has identified many obstacles to the diagnosis and management of heart failure that may explain why patients are inadequately managed in primary care. Specific implementation strategies need to be tailored to overcome these obstacles.

Aged↗
PubMed2002

Reversibility with interleukin-2 suggests that T cell anergy contributes to donor-specific hyporesponsiveness in renal transplant patients.

Data from various rodent models have implicated a role for anergic T cells in the maintenance of self and transplantation tolerance. The relevance of donor-specific T cell anergy to clinical transplantation, however, has not been demonstrated. Previous studies have reported that recipients of solid organ transplant often have reduced frequencies of CD4(+) T cells with anti-donor direct pathway allospecificity after transplantation. The underlying mechanism(s) of this donor-specific hyporesponsiveness is unclear but likely to contribute to the diminished immunosuppressive requirement of transplant patients with time after transplantation. This study shows that ex vivo treatment of CD4(+) T cells from renal transplant recipients with IL-2 could specifically increase the anti-donor frequency in all the patients with evidence of donor-specific hyporesponsiveness. It also shows that the IL-2-induced recovery of anti-donor frequency is unlikely to result from nonspecific stimulation or selective clonal expansion of activated, allospecific CD4(+) T cells. Taken together, the data suggest that T cell anergy plays an important role in the direct pathway hyporesponsiveness that evolves in many human renal transplant recipients.

Adult↗
PubMed2002

Supporting South Asian carers and those they care for: the role of the primary health care team.

BACKGROUND: Demographic and socioeconomic changes have increased policy interest in informal carers. However, despite the multicultural nature of British society, most research in this field has been in majority communities. AIM: To explore the role of the primary health care team (PHCT) in supporting carers from British South Asian communities. DESIGN OF STUDY: Qualitative study. SETTING: Four South Asian communities in Leicestershire and West Yorkshire. METHODS: Focus groups and in-depth interviews were used to assess male and female carers, supported by a literature review. RESULTS: Failure to recognise carers' needs, gaps in service provision, and communication and language issues compromised carers' ability to care. While some carers were positive about the PHCT role, the main weaknesses concerned poor consultation, PHCT attitudes towards carers, and access to appropriate services. CONCLUSION: South Asian carers' experiences largely parallel those of others, but there are some issues that are distinct, namely, language and communication barriers, culturally inappropriate services, and implicit or explicit racism. The multi-ethnic nature of Great Britain requires that professional practice enhances the ability of minority ethnic communities to provide informal care. The findings underline the important role of the PHCT in ensuring that carers' needs are taken seriously and that appropriate services reach them.

Asia↗
PubMedDate not supplied

Gait patterns after fracture of the femoral shaft in children, managed by external fixation or early hip spica cast.

The authors prospectively studied three-dimensional kinematics and kinetics of gait in children recovering from a closed, isolated, nonpathologic fracture of the femoral diaphysis, who had been randomly assigned to management by monolateral external fixation or early hip spica casting. The aims were to investigate the gait patterns soon after injury and at 2 years after injury. Children treated with external fixation, walking with the external fixator in situ, demonstrated asymmetric gait abnormalities in all three anatomic planes affecting the trunk, pelvis, hip, knee, and ankle. This appears to be a strategy to minimize movement and pain at the fixator pin sites. The gait pattern normalized rapidly after removal of the external fixator with few kinematic or kinetic abnormalities and no clinically significant disturbances of gait at 2 years after injury. In contrast, children in the early hip spica cast group developed a "crouch gait" pattern in the sagittal plane, most likely due to weakness. They also had abnormal coronal plane kinematics related to shortening of the injured side. Gait patterns improved, but at 2 years there were some persistent gait deviations, probably related to residual limb length discrepancy.

Biomechanical Phenomena↗
PubMedDate not supplied

Acculturation and diabetes among Hispanics: evidence from the 1999-2002 National Health and Nutrition Examination Survey.

OBJECTIVE: Hispanic individuals in the United States have a greater prevalence of diabetes mellitus than non-Hispanic white individuals; however, it is unclear whether Hispanics' risk of diabetes differs based on their level of acculturation. The purpose of our research was to examine acculturation among Hispanic Americans with respect to prevalence and control of diabetes. METHODS: We conducted an analysis of the National Health and Nutrition Examination Survey (NHANES), 1999-2002, a nationally representative sample of the noninstitutionalized U.S. population. We evaluated data on Hispanic adults (> or = 18 years of age, unweighted n=2,696), analyzing diagnosed diabetes, glycemic blood pressure and lipid control, and diabetes complications according to acculturation as measured by language and birth outside the United States. RESULTS: Hispanics with low acculturation were more likely to be without a routine place for health care, have no health insurance, and have low levels of education. In adjusted analyses, individuals with low acculturation, measured by language, were more likely to have diabetes (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.02, 3.54). Among individuals with diagnosed diabetes, no significant association was yielded between acculturation and diabetes control. However, individuals with low language acculturation were more likely to have the diabetes complication of peripheral neuropathy (OR 4.01, 95% CI 1.40, 11.48). CONCLUSIONS: Acculturation as measured through language is associated with diabetes and complications among Hispanics even after controlling for a variety of demographic characteristics including health insurance and education. The findings suggest that even within a "single" minority ethnic group, there are differences in disease prevalence and complications and access to health care.

Acculturation↗