'Please see and advise': a qualitative study of patients' experiences of psychiatric outpatient care.

Background: Patient evaluations have become a sensitive indicator of service delivery and the quality of care. In this study they point to a lack of clarity surrounding the role of outpatient psychiatry in relation to primary care, raising questions about the effective integration of services for patients whose needs straddle the boundaries of primary and specialist care.

Methods: Interviews with a consecutive series of 100 new referrals to two outpatient clinics compared their expectations of treatment with their subsequent experiences of psychiatric care.

Partial agonism at serotonin 5-HT1B and dopamine D2L receptors using a luciferase reporter gene assay.

We have used a luciferase reporter gene assay to study the functional responses of two G-protein-coupled receptors in Chinese hamster ovary (CHO) cells. The rank order of potency of drugs for the endogenous 5-HT1B receptor was 5-Hydroxytryptamine (5-HT) > zolmitriptan > dihydroergocristine > (-)lisuride (with no response to bromocriptine). However, only 5-HT and (-)lisuride produced a full functional response, with zolmitriptan and dihydroergocristine achieving 69+/-2% and 50+/-1% of the maximal response.

Annuitizing the human capital investment costs of health service professionals.

When evaluating initiatives that make innovative uses of staff it is important to consider the long-term cost consequences of training an appropriately qualified workforce. In order to incorporate the costs of qualifying professionals we need both the costs themselves and an appropriate method of annuitizing these costs. This paper focuses on the latter and describes an approach to estimating the expected working life of health service professionals and a method of annuitization that takes into consideration patterns of employment over time.

Attendance at cancer screening in the wake of widespread adverse publicity surrounding test results.

The largest error ever discovered in cervical smear test results was reported by an East Kent Hospitals' NHS Trust in 1996. To test whether the incident would have an impact on a separate NHS screening programme within the affected area, 1000 women who were due to be called for x ray mammography were asked how confident they would be about the accuracy of their mammogram result. Most women reported that they would be confident, but significantly fewer unconfident than confident women subsequently kept their appointment for breast screening.

Subunits of the eukaryotic cytosolic chaperonin CCT do not always behave as components of a uniform hetero-oligomeric particle.

The chaperonin CCT is an hetero-oligomeric molecular chaperone complex. Studies in yeast suggest each of its eight gene products are required for its major identified functions in producing native tubulins and actins. However, it is unclear whether these eight components always form a single particle, covering all functions, or else can also exist as heterogeneous mixtures and/or free subunits in cells.

JNK, cytoskeletal regulator and stress response kinase? A Drosophila perspective.

c-Jun N-terminal kinases (JNKs) are intracellular stress-activated signalling molecules, which are controlled by a highly evolutionarily conserved signalling cascade. In mammalian cells, JNKs are regulated by a wide variety of cellular stresses and growth factors and have been implicated in the regulation of remarkably diverse biological processes, such as cell shape changes, immune responses and apoptosis. How can such different stimuli activate the JNK pathway and what roles does JNK play in vivo? Molecular genetic analysis of the Drosophila JNK gene has started to provide answers to these questions, confirming the role of this molecule in development and stress responses and suggesting a conserved function for JNK signalling in processes such as wound healing.

Workplace bullying in NHS community trust: staff questionnaire survey.

Objectives: To determine the prevalence of workplace bullying in an NHS community trust; to examine the association between bullying and occupational health outcomes; and to investigate the relation between support at work and bullying.

Design: Questionnaire survey.

Setting: NHS community trust in the south east of England.

Selection models for repeated measurements with non-random dropout: an illustration of sensitivity.

The outcome-based selection model of Diggle and Kenward for repeated measurements with non-random dropout is applied to a very simple example concerning the occurrence of mastitis in dairy cows, in which the occurrence of mastitis can be modelled as a dropout process. It is shown through sensitivity analysis how the conclusions concerning the dropout mechanism depend crucially on untestable distributional assumptions. This example is exceptional in that from a simple plot of the data two outlying observations can be identified that are the source of the apparent evidence for non-random dropout and also provide an explanation of the behaviour of the sensitivity analysis.

Perceptions of risk in motorcyclists: unrealistic optimism, relative realism and predictions of behaviour.

In the first phase of a prospective investigation, a national sample of motorcyclists completed a postal questionnaire about their perceptions of risk, their behaviour on the roads and their history of accidents and spills. In the second phase a year later, they reported on their accident history and behaviour over the preceding 12 months. A total of 723 respondents completed both questionnaires.

Effects of stress in an NHS trust: a study.

This study of staff in an NHS trust tests two established models of occupational stress. Payne (1979) suggested that support at work can help to neutralise the strain of work demands, while Karasek (1979) suggested that staff whose jobs are characterised by high demands and low control are at greater risk of poor psychological wellbeing and ill health. Support is found for both models, and it is suggested that the two could usefully be combined.

Bovine ovarian non-genomic progesterone binding sites: presence in follicular and luteal cell membranes.

We have shown recently that the bovine corpus luteum (CL) possesses specific luteal cell surface membrane binding sites for progesterone. We have now confirmed and extended these observations to compare the subcellular distribution of these binding sites in developing, mature and regressing CL. The median buoyant densities of luteal progesterone binding sites from early-, mid- and late-luteal phase CL were similar (though three of five density profiles for late-luteal phase CL showed association of steroid binding with a fraction with a lower density), and clearly resolved from nuclear, mitochondrial, lysosomal, peroxisomal, Golgi-endoplasmic reticulum-lysosomal and smooth endoplasmic reticulum markers.

The influence of 5' codon context on translation termination in Saccharomyces cerevisiae.

Translation termination in vivo was studied in the yeast Saccharomyces cerevisiae using a translation-assay system. Codon changes that were made at position -2 relative to the stop codon, gave a 3.5-fold effect on termination in a release-factor-defective (sup45) mutant strain, in line with the effect observed in a wild-type strain.

Health promotion. Beating the bands?

A survey of health authorities in England to establish GPs' health promotion activities found that anti-smoking and heart disease prevention were the most common initiatives. Many HAs were dissatisfied with the current arrangements, feeling that they had little control of GPs' health promotion activities. Two-thirds of HAs reported problems with monitoring GPs' health promotion activities.

A geometry-and intensity-based partial volume correction for MRI volumetric studies.

Segmentation of objects of interest in magnetic resonance imaging is a necessary procedure for volumetric calculations. However, these direct measurements tend to be inaccurate due to the intrinsic MRI partial volume effects. In this paper, a general method for correcting these effects based on the geometry and grey level intensity of the segmented objects is presented.

B Vitamin deficiency and neuropsychiatric syndromes in alcohol misuse.

Alcohol misuse and alcohol withdrawal are associated with a variety of neuropsychiatric syndromes, some of which are associated with significant morbidity and mortality. B vitamin deficiency is known to contribute to the aetiology of a number of these syndromes, and B vitamin supplementation thus plays a significant part in prophylaxis and treatment. In particular, the Wernicke Korsakoff syndrome (WKS).

A virtual laboratory notebook for simulation models.

In this paper we describe how we have adopted the laboratory notebook as a metaphor for interacting with computer simulation models. This 'virtual' notebook stores the simulation output and meta-data (which is used to record the scientist's interactions with the simulation). The meta-data stored consists of annotations (equivalent to marginal notes in a laboratory notebook), a history tree and a log of user interactions.

Pharmacotherapy for people with Alzheimer's disease: a Markov-cycle evaluation of five years' therapy using donepezil.

This article combines data from a clinical trial of donepezil with costing figures to evaluate expected direct costs of care over 5 years after diagnosis of Alzheimer's disease (AD) for patients aged 75 years and over at diagnosis. A Markov model simulates the progression of elderly persons through changing levels of severity. The model compares three treatment regimes for each of two patient groups; mild AD at start of treatment; moderate AD at start of treatment.

A review of the safety and tolerability of sertindole.

The safety and efficacy of sertindole have been established in three double-blind randomized controlled studies conducted in the United States, North America and Europe. In these three studies the tendency for sertindole to cause extrapyramidal side effects (EPS), a critical factor affecting compliance, was investigated. At 12-24 mg/day, sertindole was associated with placebo levels of EPS, which were significantly lower than for all doses of haloperidol.

Managerialism and active citizenship in Britain's reformed health service: power and community in an era of decentralisation.

The creation of a large managerial stratum within the British National Health Service in recent years has been one of the most striking characteristics of reforms intended to develop a more efficient and "business-like" service. An accompanying political rhetoric of decentralisation has cast local managerial autonomy as a means to gauge and respond more easily to the needs and preferences expressed by local communities. This article therefore reviews the growth of the new managerial stratum with particular regard to its emerging relationship with the local populations in whose name the organisational reforms have been wrought.

Visual synchrony affects binding and segmentation in perception.

The visual system analyses information by decomposing complex objects into simple components (visual features) that are widely distributed across the cortex. When several objects are present simultaneously in the visual field, a mechanism is required to group (bind) together visual features that belong to each object and to separate (segment) them from features of other objects. An attractive scheme for binding visual features into a coherent percept consists of synchronizing the activity of their neural representations.

Specific non-genomic, membrane-localized binding sites for progesterone in the bovine corpus luteum.

Fractionation of bovine corpus luteum (CL) homogenates on continuous sucrose density gradients with and without preincubation with 3H-progesterone demonstrated high levels of tracer binding and high content of endogenous progesterone associated with particulate membrane fractions. Analysis of gradient fractions for a range of luteal plasma membrane and intracellular organelle marker enzyme activities indicated that endogenous progesterone content and 3H-progesterone-binding activity were associated with fractions enriched in luteal plasma membrane markers. This was confirmed by pretreatment of homogenates with the saponin, digitonin, prior to fractionation.

Olanzapine.

Olanzapine is a newly introduced atypical neuroleptic, with a broad receptor profile similar to that of clozapine. It is as effective as haloperidol against the positive symptoms of schizophrenia, and more effective against negative symptoms, with significantly fewer extrapyramidal side-effects. Side-effects include somnolence and weight gain.

The phosphorylation of eukaryotic initiation factor eIF4E in response to phorbol esters, cell stresses, and cytokines is mediated by distinct MAP kinase pathways.

Initiation factor eIF4E binds to the 5'-cap of eukaryotic mRNAs and plays a key role in the mechanism and regulation of translation. It may be regulated through its own phosphorylation and through inhibitory binding proteins (4E-BPs), which modulate its availability for initiation complex assembly. eIF4E phosphorylation is enhanced by phorbol esters.

Activation of microtubule-associated protein kinase (Erk) and p70 S6 kinase by D2 dopamine receptors.

The ability of human and rat D2(short) and D2(long) dopamine receptors to activate microtubule-associated protein (MAP) kinase (Erk1/2) and p70 S6 kinase has been investigated in recombinant cells expressing these receptors. In cells expressing the D2(short) receptor, dopamine activated both enzymes in a transient manner but with very different time courses, with activation of Erk being much quicker. Activation of both enzymes by dopamine was dose-dependent and could be prevented by a range of selective dopamine antagonists.

Patients' action during their cardiac event: qualitative study exploring differences and modifiable factors.

Objectives: To explore the circumstances and factors that explain variations in response to a cardiac event and to identify potentially modifiable factors.

Design: Qualitative analysis of semistructured, face to face interviews with patients admitted to two district hospitals for a cardiac event and with other people present at the time of the event. Patients were divided into three groups according to the length of delay between onset of symptoms and calling for medical help.