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Ord T, Metcalfe D, Greaves J, Hodgson P. Unmasking impostor phenomenon: a study of nurses in specialist roles. Br J Nurs 2024; 33:139-143. [PMID: 38335096 DOI: 10.12968/bjon.2024.33.3.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
This cross-sectional study aimed to explore the incidence of impostor phenomenon among 79 nurses in specialist roles in a single NHS trust in England, using an online anonymous questionnaire that included the Clance Imposter Phenomenon Scale and free-text responses. Results indicated a high prevalence of impostor phenomenon, with no specific variables predicting its occurrence. Four main themes emerged: self-doubt, role expectations, fear of exposure as an impostor, and factors leading to burnout. The study highlights the need for targeted support and training for this cohort, particularly as impostor phenomenon was found to be prevalent during career transitions and was not limited by gender. The findings have implications for nursing management and education, offering the opportunity to develop specific support mechanisms to alleviate impostor phenomenon and potentially reduce attrition rates in specialist nursing roles.
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Affiliation(s)
- Tracy Ord
- Assistant Professor in Nursing, Department of Nursing Midwifery and Health, Northumbria University
| | - Dale Metcalfe
- Lecturer in Psychology, Health and Life Sciences, Northumbria University
| | - Jane Greaves
- Associate Professor in Nursing, Strategic Lead-NMC Competence Test Centre, Health and Life Sciences, Northumbria University
| | - Philip Hodgson
- Assistant Professor in Nursing, Department of Nursing Midwifery and Health, Northumbria University
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2
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McKenzie K, Robson R, Murray G, Kaczmar M, Metcalfe D, Shirley A. The views of people using homeless services about learning disability. J Intellect Disabil 2023:17446295231215412. [PMID: 37949059 DOI: 10.1177/17446295231215412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
AIMS People with a learning disability are at increased risk of becoming homeless, but little is known about how learning disability is viewed by people accessing homeless services. This study aimed to obtain the views of people experiencing homelessness about learning disability, in the context of a project that was exploring how to increase identification of learning disability. METHODS A qualitative approach was used, and 19 adults were interviewed who were receiving support from homeless services in the North-East of England. Information from the interviews was analysed using thematic analysis. RESULTS Four themes were identified relating to understanding of learning disability, the role of identification, day-to-day challenges, and experiences of services. CONCLUSION There is a need to: promote better understanding of learning disability; for early identification processes that involve the person in a meaningful way; and the provision of support that is non-stigmatising, practical and which addresses health concerns.
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Affiliation(s)
| | - Ruth Robson
- Evaluation, Learning & Research Manager, Changing Lives, UK
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McKenzie K, Murray G, Metcalfe D, Robson R, Kaczmar M, Shirley A. Using the learning disability screening questionnaire to help identify people with an intellectual disability in homeless services. J Appl Res Intellect Disabil 2023; 36:1319-1325. [PMID: 37635318 DOI: 10.1111/jar.13150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/29/2023] [Accepted: 07/31/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND We explored the accuracy of using the learning disability screening questionnaire (LDSQ) in services for people experiencing homelessness in the United Kingdom. METHOD We examined the concordance between the LDSQ outcomes and assessments of intellectual disability. Seventy adults experiencing homelessness completed the LDSQ. Staff completed the LDSQ and a measure of adaptive functioning for 38 of this group. Nine participants received an intellectual assessment. RESULTS Sensitivity and specificity for the LDSQ when completed by staff was 83% and 96% respectively and 50% and 92% when completed by the individual. Seven people had intellectual and adaptive functioning in the intellectual disability range. CONCLUSION The results suggest that the LDSQ would be an appropriate and beneficial screening tool to use within services for people experiencing homelessness. More accurate results would be likely if it were completed by staff.
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Affiliation(s)
- Karen McKenzie
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | | | - Dale Metcalfe
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
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Metcalfe D, McKenzie K, McCarty K, Pollet TV, Murray G. An exploration of the impact of contextual information on the emotion recognition ability of autistic adults. Int J Psychol 2022; 57:433-442. [PMID: 35157320 PMCID: PMC9302678 DOI: 10.1002/ijop.12834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 01/06/2022] [Indexed: 11/15/2022]
Abstract
Studies of non‐autistic individuals and people with an intellectual disability show that contextual information impacts positively on emotion recognition ability, however, this area is not well researched with autistic adults. We investigated this using a static emotion recognition task. Participants completed an emotion recognition task in person or online. In total, 46 autistic participants and 379 non‐autistic participants completed the task. A linear mixed model showed that autistic adults had significantly lower accuracy when identifying emotions across all contexts, compared to control participants, even when contextual information was present. No significant effect of context was found in either group, nor was gender shown to be an influential variable. A supplementary analysis showed that higher scores on the Autism‐Spectrum Quotient led to lower scores on the emotion recognition task; no effect of context was found here either. This research adds to the limited work investigating the influence of contextual factors in emotion recognition in autistic adults. Overall, it shows that context may not aid emotion recognition in this group in the same way as it does for non‐autistic individuals.
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McKenzie K, Murray G, Martin R, Murray A, Metcalfe D. A quantitative evaluation of a regional Positive Behavioural Support workforce development approach. J Appl Res Intellect Disabil 2021; 34:1641-1654. [PMID: 34196450 DOI: 10.1111/jar.12915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/13/2021] [Accepted: 05/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Research suggests that providing staff with input in relation to Positive Behavioural Support (PBS) can have beneficial outcomes. Much of this research, however, fails to take account of systemic issues and does not include a control group. METHOD We used a non-randomised, controlled group design to evaluate accredited PBS programmes, delivered as part of a systemic, regional and workforce development approach. We compared outcomes of those attending the programmes (n = 240) with a control group (n = 54), pre- and post-intervention and at 3-months follow-up. RESULTS The programme and its wider impact were rated positively. Significant intervention effects were found for staff practice and retention, but not for staff knowledge and attributions, or behaviours that challenge and quality of life of those being supported. CONCLUSIONS The results are discussed in the context of the study limitations and restrictions resulting from the Covid-19 pandemic.
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Affiliation(s)
- Karen McKenzie
- Department of psychology, Northumbria University, Newcastle upon Tyne, UK
| | - George Murray
- Department of psychology, Northumbria University, Newcastle upon Tyne, UK.,NHS Lothian, Edinburgh, UK
| | - Rachel Martin
- Department of psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Aja Murray
- Department of psychology, University of Edinburgh, Edinburgh, UK
| | - Dale Metcalfe
- Department of psychology, Northumbria University, Newcastle upon Tyne, UK
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McKenzie K, Martin R, Metcalfe D, Murray G, McNall A, Noone S. “Look, all our hard work is paying off”: A qualitative evaluation of a system‐wide, workforce development model to promote positive behavioural support. J Appl Res Intellect Disabil 2020; 33:1512-1522. [DOI: 10.1111/jar.12778] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 06/01/2020] [Accepted: 06/08/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - George Murray
- Northumbria University Newcastle upon Tyne UK
- NHS Lothian Newcastle upon Tyne UK
| | - Anne McNall
- Northumbria University Newcastle upon Tyne UK
| | - Steve Noone
- Northumbria University Newcastle upon Tyne UK
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7
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McKenzie K, Murray A, Murray K, O'Donnell M, Murray GC, Metcalfe D, McCarty K. An evaluation of the distribution properties, factor structure, and item response profile of an assessment of emotion recognition. Heliyon 2020; 6:e03572. [PMID: 32195395 PMCID: PMC7076041 DOI: 10.1016/j.heliyon.2020.e03572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 10/01/2019] [Accepted: 03/09/2020] [Indexed: 11/18/2022] Open
Abstract
Many people with developmental disabilities, such as autism spectrum disorder and intellectual disability have emotion recognition (ER) difficulties compared with typically developing (TD) peers. Accurate assessment of the extent and nature of differences in ER requires an understanding of the response profiles to ER assessment stimuli. We analysed data from 504 TD individuals in response to an ER assessment in respect of distribution properties, factor structure, and item response profile. Eighteen emotion items discriminated better at lower levels of ER ability in TD participants. Neutral expressions were the hardest to interpret; surprise, anger, happy, and bored were easiest. The amount of contextual information in combination with the emotion being depicted also appeared to influence level of difficulty. Similar psychometric research is needed with people with developmental disabilities.
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Affiliation(s)
- Karen McKenzie
- Northumbria University, United Kingdom
- Corresponding author.
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8
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Metcalfe D, Zogg CK, Judge A, Perry DC, Gabbe B, Willett K, Costa ML. Pay for performance and hip fracture outcomes: an interrupted time series and difference-in-differences analysis in England and Scotland. Bone Joint J 2019; 101-B:1015-1023. [PMID: 31362544 PMCID: PMC6683232 DOI: 10.1302/0301-620x.101b8.bjj-2019-0173.r1] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Aims Hip fractures are associated with high morbidity, mortality, and costs. One strategy for improving outcomes is to incentivize hospitals to provide better quality of care. We aimed to determine whether a pay-for-performance initiative affected hip fracture outcomes in England by using Scotland, which did not participate in the scheme, as a control. Materials and Methods We undertook an interrupted time series study with data from all patients aged more than 60 years with a hip fracture in England (2000 to 2018) using the Hospital Episode Statistics Admitted Patient Care (HES APC) data set linked to national death registrations. Difference-in-differences (DID) analysis incorporating equivalent data from the Scottish Morbidity Record was used to control for secular trends. The outcomes were 30-day and 365-day mortality, 30-day re-admission, time to operation, and acute length of stay. Results There were 1 037 860 patients with a hip fracture in England and 116 594 in Scotland. Both 30-day (DID -1.7%; 95% confidence interval (CI) -2.0 to -1.2) and 365-day (-1.9%; 95% CI -2.5 to -1.3) mortality fell in England post-intervention when compared with outcomes in Scotland. There were 7600 fewer deaths between 2010 and 2016 that could be attributed to interventions driven by pay-for-performance. A pre-existing annual trend towards increased 30-day re-admissions in England was halted post-intervention. Significant reductions were observed in the time to operation and length of stay. Conclusion This study provides evidence that a pay-for-performance programme improved the outcomes after a hip fracture in England. Cite this article: Bone Joint J 2019;101-B:1015–1023.
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Affiliation(s)
- D Metcalfe
- Oxford Trauma, Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), John Radcliffe Hospital, Oxford, UK
| | - C K Zogg
- Yale School of Medicine, New Haven, Connecticut, USA
| | - A Judge
- Centre for Statistics in Medicine, NDORMS, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK.,Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Southmead Hospital, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre (NIHR Bristol BRC), University Hospitals Bristol NHS Foundation Trust, University of Bristol, Southmead Hospital, Bristol, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - D C Perry
- Oxford Trauma, Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), John Radcliffe Hospital, Oxford, UK
| | - B Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - K Willett
- Oxford Trauma, Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), John Radcliffe Hospital, Oxford, UK
| | - M L Costa
- Oxford Trauma, Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), John Radcliffe Hospital, Oxford, UK
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Abstract
Aims This study sought to determine the proportion of older adults with hip fractures captured by a multicentre prospective cohort, the World Hip Trauma Evaluation (WHiTE), whether there was evidence of selection bias during WHiTE recruitment, and the extent to which the WHiTE cohort is representative of the broader population of older adults with hip fractures. Patients and Methods The characteristics of patients recruited into the WHiTE cohort study were compared with those treated at WHiTE hospitals during the same timeframe and submitted to the National Hip Fracture Database (NHFD). Results Patients recruited to WHiTE were more likely to be admitted from their own home (83.5% vs 80.2%; p < 0.001) and to have a higher median Abbreviated Mental Test Score (AMTS) (9 (interquartile range (IQR) 6 to 10) vs 9 (IQR 5 to 10); p < 0.001) than those who were not recruited. In terms of WHiTE cohort generalizability, participating hospitals included a greater proportion of Major Trauma Centres (47.8% vs 7.8%) and large hospitals (997 (IQR 873 to 1290) vs 707 (459 to 903) beds) with high-volume Emergency Departments (median annual attendances of 43 981 (IQR 37 147 to 54 385) vs 35 964 (IQR 26 229 to 50 551)). However, there were few differences in baseline characteristics between patients in the WHiTE cohort and those recorded in the NHFD. Conclusion There is evidence of a weak selection bias towards recruiting fitter patients within the WHiTE cohort, which will help to put into context the findings of future studies. We conclude that the patients within the WHiTE cohort are representative of the national population of older adults with hip fractures throughout England, Wales, and Northern Ireland. Cite this article: Bone Joint J 2019;101-B:708–714.
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Affiliation(s)
- D. Metcalfe
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - M. L. Costa
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - N. R. Parsons
- Warwick Medical School, University of Warwick, Coventry, UK
| | - J. Achten
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - J. Masters
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - M. E. Png
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - S. E. Lamb
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - X. L. Griffin
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
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Metcalfe D, McKenzie K, McCarty K, Pollet TV. Emotion recognition from body movement and gesture in children with Autism Spectrum Disorder is improved by situational cues. Res Dev Disabil 2019; 86:1-10. [PMID: 30614445 DOI: 10.1016/j.ridd.2018.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 11/11/2018] [Accepted: 12/18/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Research shows people with Autism Spectrum Disorder (ASD) have poorer emotion recognition (ER) compared to their typically developing (TD) peers. However, it is not known whether this is the case when stimuli are limited to gesture and posture, and lack facial expressions. METHOD Fifty-four children with (n = 27) and without (n = 27) ASD, matched on age and gender, completed an ER task, that used dynamic stimuli. Processing style bias, Autistic-like-traits and empathy were also measured. With ER as the outcome variable, a multilevel logistic model was created. RESULTS Children with ASD were found to be significantly less accurate in identifying emotions, compared to the control group. Presence of situational cues aided both groups. Autistic-like-traits and empathy were found to correlate too highly with the diagnosed condition to use in the multilevel model. Processing style did not significantly impact ER ability. CONCLUSIONS This study supports previous research which finds ER ability in people with ASD to be poorer than that of TD peers and that situational cues can aid ER ability. Importantly, the latter is true for people with ASD. The implication of these findings are programmes that aim to improve ER should consider using cues. Limitations of the study are discussed.
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Affiliation(s)
- Dale Metcalfe
- Department of Psychology, Northumbria University, UK.
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11
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Martin R, McKenzie K, Metcalfe D, Pollet T, McCarty K. A preliminary investigation into the relationship between empathy, autistic like traits and emotion recognition. Personality and Individual Differences 2019. [DOI: 10.1016/j.paid.2018.07.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Abstract
Aims The aim of this study was to describe temporal trends and survivorship of total hip arthroplasty (THA) in very young patients, aged ≤ 20 years. Patients and Methods A descriptive observational study was undertaken using data from the National Joint Registry (NJR) for England, Wales, Northern Ireland and the Isle of Man between April 2003 and March 2017. All patients aged ≤ 20 years at the time of THA were included and the primary outcome was revision surgery. Descriptive statistics were used to summarize the data and Kaplan–Meier estimates calculated for the cumulative implant survival. Results A total of 769 THAs were performed in 703 patients. The median follow-up was 5.1 years (interquartile range (IQR) 2.6 to 7.8). Eight patients died and 35 THAs were revised. The use of metal-on-metal (MoM) bearings and resurfacing procedures declined after 2008. The most frequently recorded indications for revision were loosening (20%) and infection (20%), although the absolute risk of these events occurring was low (0.9%). Factors associated with lower implant survival were MoM and metal-on-polyethylene (MoP) bearings and resurfacing arthroplasty ( vs ceramic-on-polyethylene (CoP) and ceramic-on-ceramic (CoC) bearings, p = 0.002), and operations performed by surgeons who undertook few THAs in this age group as recorded in the NJR ( vs those with five or more recorded operations, p = 0.030). Kaplan–Meier estimates showed 96% (95% confidence interval (CI) 94% to 98%) survivorship of implants at five years. Conclusion Within the NJR, the overall survival for very young patients undergoing THA exceeded 96% during the first five postoperative years. In the absence of studies that can better account for differences in the characteristics of the patients, surgeons should consider the association between early revision and the type of implant, the number of THAs performed in these patients, and the bearing surface when performing THA in very young patients. Cite this article: Bone Joint J 2018;100-B:1320–9.
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Affiliation(s)
- D. Metcalfe
- Associate Professor of Orthopaedic and Trauma Surgery Oxford Trauma, NuffieldDepartment of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK and Consultant Orthopaedic Surgeon, Alder Hey Children’s Hospital, Liverpool, UK
| | - N. Peterson
- Specialty Registrar in Trauma & Orthopaedic Surgery, Alder Hey Children’s Hospital, Liverpool, UK
| | - J. M. Wilkinson
- Department of Oncology and Metabolism, University of Sheffield, Sorby Wing, Northern General Hospital, Sheffield, UK
| | - D. C. Perry
- Associate Professor of Orthopaedic and Trauma Surgery Oxford Trauma, NuffieldDepartment of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK and Consultant Orthopaedic Surgeon, Alder Hey Children’s Hospital, Liverpool, UK
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13
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McKenzie K, Metcalfe D, Michie A, Murray G. Service provision in Scotland for people with an intellectual disability who have, or are at risk of developing, dementia. Dementia (London) 2018; 19:736-749. [PMID: 29958499 DOI: 10.1177/1471301218785795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This research aimed to identify current national provision by health services in Scotland in relation to proactive screening and reactive assessment for people with an intellectual disability in Scotland who have, or are at risk of developing, dementia. Staff from 12 intellectual disability services, representing the 11 health board areas in Scotland, completed an online questionnaire which asked about proactive screening and reactive assessment for people with intellectual disability who had, or were at risk of developing, dementia as well as suggested areas for improvement. All of the areas provided services for people with intellectual disability who have, or are at risk of developing, dementia, but differed as to whether this was reactive, proactive or both. Nine services offered intervention following diagnosis. The most common elements used across both proactive screening and reactive assessment were conducting a health check, using a general dementia questionnaire designed for people with an intellectual disability and direct assessment with the person. Clinical psychology and community learning disability nurses were the professions most likely to be involved routinely in both proactive screening and reactive assessments. The psychometric properties of the most commonly used assessments of cognitive and behavioural functioning were mixed. The areas of improvement suggested by practitioners mainly related to ways of improving existing pathways. This research represents the first step in providing an overview of service provision in Scotland. There was some inconsistency in relation to the general and specific components which were involved in proactive screening and reactive assessment. Implications for service provision are discussed.
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Affiliation(s)
| | - Dale Metcalfe
- Northumbria University, Newcastle upon Tyne, UK.,Northumbria University, Newcastle upon Tyne, UK
| | - Amanda Michie
- NHS Lothian, Edinburgh, UK.,Northumbria University, Newcastle upon Tyne, UK
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14
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McKenzie K, Metcalfe D, Murray G. A review of measures used in the screening, assessment and diagnosis of dementia in people with an intellectual disability. J Appl Res Intellect Disabil 2018; 31:725-742. [DOI: 10.1111/jar.12441] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Karen McKenzie
- Department of Psychology; Northumbria University; Newcastle upon Tyne UK
| | - Dale Metcalfe
- Department of Psychology; Northumbria University; Newcastle upon Tyne UK
| | - George Murray
- Department of Psychology; Northumbria University; Newcastle upon Tyne UK
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15
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McKenzie K, Murray AL, Wilkinson A, Murray GC, Metcalfe D, O'Donnell M, McCarty K. The relations between processing style, autistic-like traits, and emotion recognition in individuals with and without Autism Spectrum Disorder. Personality and Individual Differences 2018. [DOI: 10.1016/j.paid.2017.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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16
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Metcalfe D, Perry DC, Bouamra O, Salim A, Woodford M, Edwards A, Lecky FE, Costa ML. Regionalisation of trauma care in England. Bone Joint J 2017; 98-B:1253-61. [PMID: 27587529 DOI: 10.1302/0301-620x.98b9.37525] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 05/09/2016] [Indexed: 02/03/2023]
Abstract
AIMS We aimed to determine whether there is evidence of improved patient outcomes in Major Trauma Centres following the regionalisation of trauma care in England. PATIENTS AND METHODS An observational study was undertaken using the Trauma Audit and Research Network (TARN), Hospital Episode Statistics (HES) and national death registrations. The outcome measures were indicators of the quality of trauma care, such as treatment by a senior doctor and clinical outcomes, such as mortality in hospital. RESULTS AND CONCLUSION A total of 20 181 major trauma cases were reported to TARN during the study period, which was 270 days before and after each hospital became a Major Trauma Centre. Following regionalisation of trauma services, all indicators of the quality of care improved, fewer patients required secondary transfer between hospitals and a greater proportion were discharged with a Glasgow Outcome Score of "good recovery". In this early post-implementation analysis, there were a number of apparent process improvements (e.g. time to CT) but no differences in either crude or adjusted mortality. The overall number of deaths following trauma in England did not change following the national reconfiguration of trauma services. Evidence from other countries that have regionalised trauma services suggests that further benefits may become apparent after a period of maturing of the trauma system. Cite this article: Bone Joint J 2016;98-B:1253-61.
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Affiliation(s)
- D Metcalfe
- University of Oxford, NDORMS, Oxford, OX3 7HE, UK
| | - D C Perry
- University of Liverpool, Liverpool, Institute of Translational Medicine, Liverpool, L12 2AP, UK
| | - O Bouamra
- University of Manchester, Trauma Audit and Research Network, Salford, Manchester, M6 8HD, UK
| | - A Salim
- Harvard Medical School, Center for Surgery and Public Health, Boston, MA 02115, USA
| | - M Woodford
- University of Manchester, Trauma Audit and Research Network, Salford, Manchester, M6 8HD, UK
| | - A Edwards
- University of Manchester, Trauma Audit and Research Network, Salford, Manchester, M6 8HD, UK
| | - F E Lecky
- University of Sheffield, School of Health and Related Research, Sheffield, S1 4DA, UK
| | - M L Costa
- University of Oxford, NDORMS, Oxford, OX3 7HE, UK
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Metcalfe D, Aquilina AL, Hedley HM. Prophylactic antibiotics in open distal phalanx fractures: systematic review and meta-analysis. J Hand Surg Eur Vol 2016; 41:423-30. [PMID: 26329883 DOI: 10.1177/1753193415601055] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 07/07/2015] [Indexed: 02/03/2023]
Abstract
A systematic review was conducted on 30 December 2014 to determine whether prophylactic antibiotics reduce the risk of superficial infection and osteomyelitis following open distal phalanx fractures. Four randomized controlled trials (353 fractures) were suitable for meta-analysis. There was no statistically significant difference between rates of superficial infection in the two groups. This finding persisted when only the two most recent and highest quality trials were included. There were no reported cases of osteomyelitis in the pooled dataset, despite patients with 164 fractures not receiving antibiotics. These results fail to show any effect of prophylactic antibiotics on the rate of superficial infections following open distal phalanx fractures. The focus of treatment should be on prompt irrigation and debridement rather than administration of prophylactic antibiotics.
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Affiliation(s)
- D Metcalfe
- University Hospital Coventry & Warwickshire, Coventry, UK Harvard Medical School, Boston, MA, USA
| | - A L Aquilina
- University Hospital Coventry & Warwickshire, Coventry, UK
| | - H M Hedley
- University Hospital Coventry & Warwickshire, Coventry, UK
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Metcalfe D, Gabbe BJ, Perry DC, Harris MB, Ekegren CL, Zogg CK, Salim A, Costa ML. Quality of care for patients with a fracture of the hip in major trauma centres. Bone Joint J 2016; 98-B:414-9. [DOI: 10.1302/0301-620x.98b3.36904] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aims In this study, we aimed to determine whether designation as a major trauma centre (MTC) affects the quality of care for patients with a fracture of the hip. Patients and Methods All patients in the United Kingdom National Hip Fracture Database, between April 2010 and December 2013, were included. The indicators of quality that were recorded included the time to arrival on an orthopaedic ward, to review by a geriatrician, and to operation. The clinical outcomes were the development of a pressure sore, discharge home, length of stay, in-hospital mortality, and re-operation within 30 days. Results There were 289 466 patients, 49 350 (17%) of whom were treated in hospitals that are now MTCs. Using multivariable logistic and generalised linear regression models, there were no significant differences in any of the indicators of the quality of care or clinical outcomes between MTCs, hospitals awaiting MTC designation and non-MTC hospitals. Conclusion These findings suggest that the regionalisation of major trauma in England did not improve or compromise the overall care of elderly patients with a fracture of the hip. Take home message: There is no evidence that reconfiguring major trauma services in England disrupted the treatment of older adults with a fracture of the hip. Cite this article: Bone Joint J 2016;98-B:414–19.
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Affiliation(s)
| | - B. J. Gabbe
- Monash University, 99
Commercial Road, Melbourne, Vic
3004, Australia
| | - D. C. Perry
- University of Liverpool, Liverpool, L12
2AP, UK
| | - M. B. Harris
- Brigham Women’s Hospital, 75
Francis Street, Boston, MA
02115, USA
| | - C. L. Ekegren
- Monash University, 99
Commercial Road, Melbourne, Vic
3004, Australia
| | - C. K. Zogg
- Harvard Medical School, One
Brigham Circle, Boston, MA
02115, USA
| | - A. Salim
- Harvard Medical School, One
Brigham Circle, Boston, MA
02115, USA
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19
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Hickson CJ, Metcalfe D, Elgohari S, Oswald T, Masters JP, Rymaszewska M, Reed MR, Sprowson AP. Prophylactic antibiotics in elective hip and knee arthroplasty: an analysis of organisms reported to cause infections and National survey of clinical practice. Bone Joint Res 2015; 4:181-9. [PMID: 26585304 PMCID: PMC4664867 DOI: 10.1302/2046-3758.411.2000432] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objectives We wanted to investigate regional variations in the organisms
reported to be causing peri-prosthetic infections and to report
on prophylaxis regimens currently in use across England. Methods Analysis of data routinely collected by Public Health England’s
(PHE) national surgical site infection database on elective primary
hip and knee arthroplasty procedures between April 2010 and March
2013 to investigate regional variations in causative organisms.
A separate national survey of 145 hospital Trusts (groups of hospitals
under local management) in England routinely performing primary
hip and/or knee arthroplasty was carried out by standard email questionnaire. Results Analysis of 189 858 elective primary hip and knee arthroplasty
procedures and 1116 surgical site infections found statistically
significant variations for some causative organism between regions.
There was a 100% response rate to the prophylaxis questionnaire
that showed substantial variation between individual trust guidelines.
A number of regimens currently in use are inconsistent with the
best available evidence. Conclusions The approach towards antibiotic prophylaxis in elective arthroplasty
nationwide reveals substantial variation without clear justification.
Only seven causative organisms are responsible for 89% of infections
affecting primary hip and knee arthroplasty, which cannot justify
such widespread variation between prophylactic antibiotic policies. Cite this article: Bone Joint Res 2015;4:181–189.
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Affiliation(s)
- C J Hickson
- Leicester Royal Infirmary, Infirmary square, Leicester, LE1 5WW, UK
| | - D Metcalfe
- Harvard Medical School, One Brigham Circle, Boston, Massachusetts, 02115, USA
| | - S Elgohari
- Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - T Oswald
- Northumbria Healthcare NHS Foundation Trust, Woodhorn Lane, Ashington, Northumberland, NE63 9JJ, UK
| | - J P Masters
- Warwick Orthopaedics, Clinical Sciences Building, University Hospital Coventry and Warwickshire, Coventry, CV2 2DX, UK
| | - M Rymaszewska
- Wansbeck Hospital, Woodhorn Ln, Ashington, Northumberland NE63 9JJ, UK
| | - M R Reed
- Newcastle University and Northumbria Healthcare NHS Foundation Trust, Woodhorn Lane, Ashington, Northumberland, NE63 9JJ, UK
| | - A P Sprowson
- University of Warwick and University Hospitals Coventry and Warwickshire, Clinical Sciences Building, Coventry, CV2 2DX, UK
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20
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Metcalfe D, Bouamra O, Parsons NR, Aletrari MO, Lecky FE, Costa ML. Effect of regional trauma centralization on volume, injury severity and outcomes of injured patients admitted to trauma centres. Br J Surg 2014; 101:959-64. [PMID: 24915789 DOI: 10.1002/bjs.9498] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2014] [Indexed: 11/06/2022]
Abstract
BACKGROUND Centralization of complex healthcare services into specialist high-volume centres is believed to improve outcomes. For injured patients, few studies have evaluated the centralization of major trauma services. The aim of this study was to evaluate how a regional trauma network affected trends in admissions, case mix, and outcomes of injured patients. METHODS A retrospective before-after study was undertaken of severely injured patients attending four hospitals that became major trauma centres (MTCs) in March 2012. Consecutive patients with major trauma were identified from a national registry and divided into two groups according to injury before or after the launch of a new trauma network. The two cohorts were compared for differences in case mix, demand on hospital resources, and outcomes. RESULTS Patient volume increased from 442 to 1326 (200 per cent), operations from 349 to 1231 (253 per cent), critical care bed-days from 1100 to 3704 (237 per cent), and total hospital bed-days from 7910 to 22,772 (188 per cent). Patient age increased on MTC designation from 45.0 years before March 2012 to 48.2 years afterwards (P = 0.021), as did the proportion of penetrating injuries (1.8 versus 4.1 per cent; P = 0.025). Injury severity fell as measured by median Injury Severity Score (16 versus 14) and Revised Trauma Score (4.1 versus 7.8). Fewer patients required secondary transfer to a MTC from peripheral hospitals (19.9 versus 16.1 per cent; P = 0.100). There were no significant differences in total duration of hospital stay, critical care requirements or mortality. However, there was a significant increase, from 55.5 to 62.3 per cent (P < 0.001), in the proportion of patients coded as having a 'good recovery' at discharge after institution of the trauma network. CONCLUSION MTC designation leads to an increased case volume with considerable implications for operating theatre capacity and bed occupancy. Although no mortality benefit was demonstrated within 6 months of establishing this trauma network, early detectable advantages included improved functional outcome at discharge.
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Affiliation(s)
- D Metcalfe
- Warwick Medical School, University of Warwick, Coventry, UK; College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
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21
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Adelakun O, Metcalfe D, Tshabalala P, Stafford B, Oni B. The effect of pectinase enzyme on some quality attributes of a Nigerian mango juice. ACTA ACUST UNITED AC 2013. [DOI: 10.1108/nfs-04-2012-0041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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22
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Edwards C, Metcalfe D, Burr A, Watson K, Steward FCN, Jepson MH, van Zwanenberg TD. Influence of patient age on drug costs: An investigation to validate the prescribing unit. International Journal of Pharmacy Practice 2011. [DOI: 10.1111/j.2042-7174.1991.tb00540.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract
The costs of 15,226 drug items prescribed by 22 doctors in two UK health centres were analysed with respect to patients' age and gender. For patients aged 65 and over, average drug costs per practice patient at the health centres were, respectively, 3.6 and 5.2 times greater, and the number of prescribed items 3.3 and 5.6 times greater, than for patients under 65. When analysed in 10 patient-age bands, there was a gradual increase in the number of prescribed items and average costs from the age of 35 to 74 years at each centre. Items and costs decreased for patients aged 75 and over. The increase in costs was the consequence of a general increase in prescribed items throughout the major therapeutic groups. The findings suggest that the prescribing unit, which is a weighting factor for age currently employed to standardise populations when making interpractice comparisons of prescribing costs, may not be wholly appropriate and could conceal important differences in some patient groups, especially the middle age ranges of 35 to 64 years.
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Affiliation(s)
- C Edwards
- Wolfson Unit of Clinical Pharmacology, The University, Newcastle upon Tyne NE1 7RU
| | - D Metcalfe
- Pharmacy Practice Unit, Sunderland Polytechnic, Sunderland
| | - A Burr
- Pharmacy Practice Unit, Sunderland Polytechnic, Sunderland
| | - K Watson
- Pharmacy, Pallion Health Centre, Sunderland
| | | | - M H Jepson
- Pharmacy Practice Research Group, Aston University, Birmingham
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23
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Pert P, Butler J, Brodie J, Bruce C, Honzák M, Kroon F, Metcalfe D, Mitchell D, Wong G. A catchment-based approach to mapping hydrological ecosystem services using riparian habitat: A case study from the Wet Tropics, Australia. Ecological Complexity 2010. [DOI: 10.1016/j.ecocom.2010.05.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
BACKGROUND Celebrity diagnoses can have important effects on public behaviour. UK television celebrity Jade Goody died from cervical cancer in 2009. We investigated the impact of her illness on media coverage of cervical cancer prevention, health information seeking behaviour and cervical screening coverage. METHODS National UK newspaper articles containing the words 'Jade Goody' and 'cancer' were examined for public health messages. Google Insights for Search was used to quantify Internet searches as a measure of public health information seeking. Cervical screening coverage data were examined for temporal associations with this story. RESULTS Of 1203 articles, 116 (9.6%) included a clear public health message. The majority highlighted screening (8.2%). Fewer articles provided advice about vaccination (3.0%), number of sexual partners (1.4%), smoking (0.6%) and condom use (0.4%). Key events were associated with increased Internet searches for 'cervical cancer' and 'smear test', although only weakly with searches for 'HPV'. Cervical screening coverage increased during this period. CONCLUSION Increased public interest in disease prevention can follow a celebrity diagnosis. Although media coverage sometimes included public health information, articles typically focused on secondary instead of primary prevention. There is further potential to maximize the public health benefit of future celebrity diagnoses.
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Affiliation(s)
- D Metcalfe
- Institute of Clinical Education, Warwick Medical School, Coventry, UK.
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25
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Ostonen I, Püttsepp Ü, Biel C, Alberton O, Bakker MR, Lõhmus K, Majdi H, Metcalfe D, Olsthoorn AFM, Pronk A, Vanguelova E, Weih M, Brunner I. Specific root length as an indicator of environmental change. Plant Biosystems - An International Journal Dealing with all Aspects of Plant Biology 2007. [PMID: 0 DOI: 10.1080/11263500701626069] [Citation(s) in RCA: 167] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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26
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Abstract
Many natural enemies do not immediately kill their host, and the lag this creates between attack and host death results in mixed populations of uninfected and infected hosts. Both competition and parasitism are known to be major structuring forces in ecological communities; however, surprisingly little is known about how the competitive nature of infected hosts could affect the survival and dynamics of remaining uninfected host populations. Using a laboratory system comprising the Indian meal moth, Plodia interpunctella, and a solitary koinobiont parasitoid, Venturia canescens, we address this question by conducting replicated competition experiments between the unparasitized and parasitized classes of host larvae. For varying proportions of parasitized host larvae and competitor densities, we consider the effects of competition within (intraclass) and between (interclass) unparasitized and parasitized larvae on the survival, development time, and size of adult moths and parasitoid wasps. The greatest effects were on survival: increased competitor densities reduced survival of both parasitized and unparasitized larvae. However, unparasitized larvae survival, but not parasitized larvae survival, was reduced by increasing interclass competition. To our knowledge, this is the first experimental demonstration of the competitive superiority of parasitized over unparasitized hosts for limiting resources. We discuss possible mechanisms for this phenomenon, why it may have evolved, and its possible influence on the stability of host-parasite dynamics.
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Affiliation(s)
- T C Cameron
- Genetics, Ecology and Evolution Research Group, Institute of Integrative and Comparative Biology, University of Leeds, Leeds, UK.
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27
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Soule B, Simone N, Brown J, Metcalfe D, Mitchell J. 2621. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.1035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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28
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Abstract
OBJECTIVES There is some evidence that besides affecting peripheral neural function diabetes may also cause more widespread changes in the central nervous system which reduce cognitive efficiency and so, also, independence and quality of life. The present study explores whether diabetes mellitus is a compounding factor in average declines in cognitive performance observed in old age. DESIGN A sample of diabetics and controls were compared on a battery of cognitive tasks previously used in cognitive ageing research. METHODS Thirty-three insulin dependent (IDDM), 135 non-insulin dependent (NIDDM) diabetics and 2191 non-diabetics aged between 50 and 91 years were compared on two tests of general intellectual ability, and on three tests of verbal memory. RESULTS Overall, the combined IDDM and NIDDM groups had significantly lower average scores than the controls group on all cognitive tasks. Detailed analyses revealed most cognitive impairment for the NIDDM sub-group whose condition was managed by hypoglycaemic drugs, slightly less for those managed by diet, and no impairment for the IDDM group. These effects were independent of age, depression, socio-economic status, and presence of other illnesses. CONCLUSIONS Together with other recent studies these data emphasize the need for early detection and effective management of diabetes in older patients.
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Affiliation(s)
- N Bent
- Research School of Medicine, Rheumatology and Rehabilitation Research Unit, University of Leeds, UK
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29
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Pauls JD, Brems J, Pockros PJ, Saven A, Wagner RL, Weber R, Metcalfe D, Christiansen SC. Mastocytosis: diverse presentations and outcomes. Arch Intern Med 1999; 159:401-5. [PMID: 10030315 DOI: 10.1001/archinte.159.4.401] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Within the general category of mastocytosis lies an array of clinical presentations with differing prognostic implications. We report 3 cases of systemic mastocytosis distinguished by novel aspects of the disease. Case 1 documents the first successful orthotopic liver transplantation in a patient with mastocytosis; case 2 depicts a potential hereditary component of mastocytosis; and case 3 documents the progression of mastocytosis with hematologic abnormality to mast cell leukemia. Future investigations, such as the early definition of c-kit receptor mutations, may provide additional insight as to the molecular basis for this heterogeneous disease and guidance for prognostic implications and targeted therapies.
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Affiliation(s)
- J D Pauls
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, La Jolla, Calif 92037, USA
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30
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Abstract
AIM To identify the core content for the new undergraduate medical curriculum in Manchester. METHOD The initial step was to produce a list of 'index clinical situations' (ICSs), for which a newly graduated doctor must have a required level of competence. Using repeated consultation with consultants and general practitioners involved in medical education in the North-West of England, a list of 215 ICSs was agreed. Specialists and generalists were then asked to identify the components of the knowledge base and the performance (skills) base for each ICS. The knowledge base was divided into technical (biomedical facts/concepts) and contextual (effect/management of disease within the individual, family and society) domains. The performance base was divided into intellectual (problem solving and decision making) and interpersonal (history, examination, communication and procedural skills) domains. RESULTS Forty specialties were consulted and 11,021 items (defined as a piece of knowledge, a concept or a skill) were identified. There was considerable overlap in the items listed, such that when the returns for each ICS were amalgamated, the 215 ICSs contained 6434 items with a mean of 34 +/- 14.2 per situation (range 6-85). UTILISATION: We have used the defined ICSs in the design of the trigger material used in the weekly problem-based learning sessions. Over 4 years almost all (207/215, 96%) of the ICS are covered, with many being revisited at several points in the curriculum.
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Affiliation(s)
- P A O'Neill
- Department of Geriatric Medicine, University of Manchester, UK
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31
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Metcalfe D. Ethical debate. Truth, the first casualty. Doctors and patients should be fellow travellers. BMJ 1998; 316:1892-3. [PMID: 9669847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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32
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Metcalfe D. 'Cultural imperialism': a danger? Med Educ 1996; 30:3. [PMID: 8736180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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33
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McBride M, Metcalfe D. General practitioners' low morale: reasons and solutions. Br J Gen Pract 1995; 45:227-9. [PMID: 7619566 PMCID: PMC1239225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- M McBride
- Royal College of General Practitioners, Hyde Park, London
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34
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Taub D, Dastych J, Inamura N, Upton J, Kelvin D, Metcalfe D, Oppenheim J. Bone marrow-derived murine mast cells migrate, but do not degranulate, in response to chemokines. The Journal of Immunology 1995. [DOI: 10.4049/jimmunol.154.5.2393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
We have determined that several chemokines induce mast cell migration in vitro. This directed migration is dependent on the presence of particular extracellular matrix proteins and the activation status of the cells. Mast cell haptotactic responses were observed in response to various chemokines on vitronectin-, laminin-, and fibronectin-coated filters. Unstimulated mast cells were chemoattracted only by monocyte chemotactic protein-1 and RANTES on vitronectin-coated and, to a lesser extent, laminin-coated filters, whereas IgE-activated mast cells migrated in response to monocyte chemotactic protein-1, regulated on activation normal T expressed and secreted, platelet factor-4, and macrophage inflammatory protein-1 alpha on all three matrix proteins. No significant migration was observed on collagen type IV-coated or uncoated filters. Mast cell migration in response to chemokines on extracellular matrices and its enhancement by IgE-dependent activation provide a mechanism by which cells may be drawn to sites of inflammation. Chemokine-induced mast cell recruitment may be particularly relevant in host defense responses to parasitic infections, allergic reactions, Jones-Mote reactions, and in wound healing.
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Affiliation(s)
- D Taub
- Clinical Services Program, National Cancer Institute-Frederick Cancer Research and Development Center, MD 21702
| | - J Dastych
- Clinical Services Program, National Cancer Institute-Frederick Cancer Research and Development Center, MD 21702
| | - N Inamura
- Clinical Services Program, National Cancer Institute-Frederick Cancer Research and Development Center, MD 21702
| | - J Upton
- Clinical Services Program, National Cancer Institute-Frederick Cancer Research and Development Center, MD 21702
| | - D Kelvin
- Clinical Services Program, National Cancer Institute-Frederick Cancer Research and Development Center, MD 21702
| | - D Metcalfe
- Clinical Services Program, National Cancer Institute-Frederick Cancer Research and Development Center, MD 21702
| | - J Oppenheim
- Clinical Services Program, National Cancer Institute-Frederick Cancer Research and Development Center, MD 21702
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35
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Taub D, Dastych J, Inamura N, Upton J, Kelvin D, Metcalfe D, Oppenheim J. Bone marrow-derived murine mast cells migrate, but do not degranulate, in response to chemokines. J Immunol 1995; 154:2393-402. [PMID: 7532669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We have determined that several chemokines induce mast cell migration in vitro. This directed migration is dependent on the presence of particular extracellular matrix proteins and the activation status of the cells. Mast cell haptotactic responses were observed in response to various chemokines on vitronectin-, laminin-, and fibronectin-coated filters. Unstimulated mast cells were chemoattracted only by monocyte chemotactic protein-1 and RANTES on vitronectin-coated and, to a lesser extent, laminin-coated filters, whereas IgE-activated mast cells migrated in response to monocyte chemotactic protein-1, regulated on activation normal T expressed and secreted, platelet factor-4, and macrophage inflammatory protein-1 alpha on all three matrix proteins. No significant migration was observed on collagen type IV-coated or uncoated filters. Mast cell migration in response to chemokines on extracellular matrices and its enhancement by IgE-dependent activation provide a mechanism by which cells may be drawn to sites of inflammation. Chemokine-induced mast cell recruitment may be particularly relevant in host defense responses to parasitic infections, allergic reactions, Jones-Mote reactions, and in wound healing.
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Affiliation(s)
- D Taub
- Clinical Services Program, National Cancer Institute-Frederick Cancer Research and Development Center, MD 21702
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36
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McBride M, Colvin P, Metcalfe D, Jee M. GPs and managers. What the doctors saw. Health Serv J 1994; 104:24-6. [PMID: 10138568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Low morale among many GPs was the trigger for a survey which examined the causes of communication breakdowns and misunderstandings. Mollie McBride and colleagues outline the results.
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Affiliation(s)
- M McBride
- Royal College of General Practitioners
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37
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Abstract
One of the aims of the Tomlinson report is to shift more care from the secondary to the primary sector in London. But the primary sector is already underresourced and overloaded. The capital has a heterogeneous population which often makes inappropriate demands on general practitioners. Many premises are inadequate and there are insufficient support staff. David Metcalfe emphasises that London is special and that the shift will not become a reality unless these problems are tackled. He suggests the establishment of different models of practice centres which could treat some of the patients who now go to accident and emergency departments. Some would be the night emergency service base, some would have primary care beds, and each would have a different mix of specialist support.
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Affiliation(s)
- D Metcalfe
- Department of General Practice, University of Manchester
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38
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Affiliation(s)
- D Metcalfe
- Department of General Practice, University of Manchester
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39
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Horder J, Metcalfe D. Requirements for technology. As seen by providers of primary health care. Int J Technol Assess Health Care 1988; 5:91-101. [PMID: 10292547 DOI: 10.1017/s0266462300005985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This article is concerned with principles that might help to ensure that procedures and tools used in primary care are appropriate to people's needs and expectations. It urges attention, not first to technology, but to the broad range of purposes served by primary care and to the relevance of procedures to them. Other criteria for ensuring appropriateness are also proposed.
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40
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Kettelhut B, Parker R, Travis W, Metcalfe D. 336 Identification of focal mast cell lesions in the bone marrow of children with mastocytosis. J Allergy Clin Immunol 1988. [DOI: 10.1016/0091-6749(88)90570-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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41
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Metcalfe D. William Pickles lecture 1986. The crucible. J R Coll Gen Pract 1986; 36:349-54. [PMID: 3735222 PMCID: PMC1960604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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42
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43
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Wilkin D, Metcalfe D. How hard do general practitioners work? West J Med 1985. [DOI: 10.1136/bmj.290.6461.67-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
Detailed classification of morbidity data provides problems in large-scale surveys in general practice: a balance between precise diagnosis and realistic uncertainty must be maintained, and it can be hard to detect the overall pattern when a large number of rubrics is involved. This paper reports the development of a system of clustered diagnoses in which similar diagnoses are linked together in homogeneous clusters. The system is based on the RCGP codes and is compatible with ICHPPC-2. The aim was not to produce another classification of morbidity but to use the system to apply to data already coded using a specific primary code.
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45
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46
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Metcalfe D. Trends in the utilization of the National Health Service. J R Coll Gen Pract 1983; 33:615-7. [PMID: 6644664 PMCID: PMC1973063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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47
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Freeman J, Roberts J, Metcalfe D, Hillier V. The influence of trainers on trainees in general practice. J R Coll Gen Pract Occas Pap 1982:1-17. [PMID: 7186075 PMCID: PMC2573546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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