Dark Matter Search Results from the PICO-60 C_{3}F_{8} Bubble Chamber.

New results are reported from the operation of the PICO-60 dark matter detector, a bubble chamber filled with 52 kg of C_{3}F_{8} located in the SNOLAB underground laboratory. As in previous PICO bubble chambers, PICO-60 C_{3}F_{8} exhibits excellent electron recoil and alpha decay rejection, and the observed multiple-scattering neutron rate indicates a single-scatter neutron background of less than one event per month. A blind analysis of an efficiency-corrected 1167-kg day exposure at a 3.3-keV thermodynamic threshold reveals no single-scattering nuclear recoil candidates, consistent with the predicted background. These results set the most stringent direct-detection constraint to date on the weakly interacting massive particle (WIMP)-proton spin-dependent cross section at 3.4×10^{-41} cm^{2} for a 30-GeV c^{-2} WIMP, more than 1 order of magnitude improvement from previous PICO results.

Pharmaceutical care for elderly patients shared between community pharmacists and general practitioners: a randomised evaluation. RESPECT (Randomised Evaluation of Shared Prescribing for Elderly people in the Community over Time) [ISRCTN16932128].

BACKGROUND: This trial aims to investigate the effectiveness and cost implications of 'pharmaceutical care' provided by community pharmacists to elderly patients in the community. As the UK government has proposed that by 2004 pharmaceutical care services should extend nationwide, this provides an opportunity to evaluate the effect of pharmaceutical care for the elderly. DESIGN: The trial design is a randomised multiple interrupted time series. We aim to recruit 700 patients from about 20 general practices, each associated with about three community pharmacies, from each of the five Primary Care Trusts in North and East Yorkshire. We shall randomise the five resulting groups of practices, pharmacies and patients to begin pharmaceutical care in five successive phases. All five will act as controls until they receive the intervention in a random sequence. Until they receive training community pharmacists will provide their usual dispensing services and so act as controls. The community pharmacists and general practitioners will receive training in pharmaceutical care for the elderly. Once trained, community pharmacists will meet recruited patients, either in their pharmacies (in a consultation room or dispensary to preserve confidentiality) or at home. They will identify drug-related issues/problems, and design a pharmaceutical care plan in conjunction with both the GP and the patient. They will implement, monitor, and update this plan monthly. The primary outcome measure is the 'Medication Appropriateness Index'. Secondary measures include adverse events, quality of life, and patient knowledge and compliance. We shall also investigate the cost of pharmaceutical care to the NHS, to patients and to society as a whole.

Evaluation of the effectiveness of UK community pharmacists' interventions in community palliative care.

INTRODUCTION: In 1997, the Royal Pharmaceutical Society of Great Britain Working Party reported that UK community pharmacists had a crucial role in effective medicines management and effective symptom control for those receiving palliative care in the community. However, prior to the integration of community pharmacists into the community palliative team, it is necessary to evaluate the effectiveness of their pharmaceutical interventions. AIM: To assess the effectiveness of community pharmacists' clinical interventions in supporting palliative care patients in primary care using an independent multidisciplinary panel review. METHODS: Patients with a life expectancy of less than 12 months were each registered with a single pharmacy and their consent was obtained for the community pharmacists to access their general practitioner (GP) case records. The community pharmacists received training in palliative pharmaceutical care and documenting interventions. The trained community pharmacists provided palliative pharmaceutical care to the recruited patients. At the end of a 10-month period, the clinical interventions were reviewed by an independent multidisciplinary expert panel consisting of a palliative care consultant, a Macmillan nurse (community palliative care nurse) and a hospital pharmacist with special interest in palliative care. RESULTS: Fourteen community palliative care teams (including community pharmacists, GPs and community nurses) took part in the study and 25 patients were recruited over the 10-month recording period. All but one patient had a diagnosis of cancer; the other patient had chronic obstructive pulmonary disease. By the end of the project, 14 patients had died. Community pharmacists recorded a total of 130 clinical interventions. Thirty interventions were excluded as insufficient information had been documented to allow review by the panel. Eighty-one per cent of the interventions were judged by the expert panel likely to be beneficial. However, 3% were judged likely to be detrimental to the patients' well-being. CONCLUSIONS: Most of the clinical interventions made by the community pharmacists for palliative pharmaceutical care were judged by the expert panel as being likely to be beneficial. The result supports the view that when community pharmacists are appropriately trained and included as integrated members of the team, they can intervene effectively to improve pharmaceutical care for palliative care patients.

Smoking cessation. Pulling out the stops.

The launch of smoking-cessation drug Zyban in June last year greatly increased demand on a local smoking-cessation service. It is important to use local media to increase awareness of local services. Health authorities and pharmaceutical companies should work with the media when new drugs may put extra strain on local services.

Achieving a patient-centred consultation by giving feedback in its early phases.

The traditional medical consultation comprises history, examination, and investigations, followed by explanation to the patient of diagnosis and management. In the course of studying a series of tape-recorded consultations in a specialist medical clinic for chronic fatigue, we have observed a different structure. In some consultations, those categorized as more 'patient-centred', doctors introduced explanation and education into the early history-taking stage. This strategy is contrasted with the traditional approach, where the doctor only elicits information during the history, and gives an explanation later. The 'early feedback' strategy may result in patients with chronic illnesses achieving greater understanding of their symptoms. We discuss the implication of these findings for medical training.

Assessing physicians' interpersonal skills via videotaped encounters: a new approach for the Royal College of General Practitioners Membership examination.

The Royal College of General Practitioners' Membership examination, the only postgraduate qualification in family medicine in the United Kingdom, has developed a direct assessment of candidates' interpersonal skills performance using videotaped consultations of the actual doctor-patient encounters. At present about 1,200 doctors are examined each year. The methodology has been developed and piloted over a period of eight years. The central tenet of the methodology is a clear definition, which is known both to the candidate and to the examiner, of the clinical and consulting competencies that are required to be demonstrated in order to pass the examination. The candidate is required to provide evidence of his or her competence usually by selecting appropriate patient encounters that demonstrate the fulfillment of the required performance criteria, effectively producing a portfolio of his or her communicative competence. The methodology is intended to encourage the learning and teaching of communication skills by making it part of an important examination and clearly defining the competencies required to pass. Reliability has been demonstrated to be satisfactory and refinement of the marking processes is likely to improve this further.

Compliance in a screening program for neuroblastoma.

BACKGROUND: The Quebec Screening Program for neuroblastoma was undertaken to determine if routine screening of infants for neuroblastoma would decrease the mortality rate from this cancer. All 476,603 children born in Quebec during a 5-year period (1989 to 1994) were offered this screening at ages 3 weeks and 6 months. Through various strategies, an attempt was made to attain the highest level of voluntary compliance possible. METHODS: Each screening consisted of the analysis of the catecholamine metabolites vanillylmandelic acid and homovanillic acid on a dry, urine-saturated filter paper mailed to a central laboratory by the parents. The strategies employed to optimize compliance consisted of increasing the awareness of the parents, health professionals, and the public about neuroblastoma and the screening program. RESULTS: The population responded well to this public health measure, with a 91% compliance rate at 3 weeks and a 74% compliance rate at 6 months. CONCLUSIONS: A well-informed population accustomed to voluntary screening for metabolic disease in infants responds well to screening for cancer.

The outpatient experience: results of a patient feedback survey.

Patient surveys can be used to enable hospital management to evaluate the services they provide. This study shows high levels of patient satisfaction with the quality of their consultations and the attitude shown to them by medical staff. Patient feedback shows that despite the introduction of the Patients' Charter, waiting times from referral to appointment and delays in clinics are still identified as the main areas for improvement. Findings show that patients are, however, remarkably tolerant and understanding of the pressures and demands placed upon outpatient staff.

Clinical terminology: anxiety and confusion amongst families undergoing genetic counseling.

Genetic counseling is a rapidly expanding, but highly demanding, domain of doctor-patient communication. This paper reports results from an ethnographic study of families (n = 30) attending a genetic counseling clinic in Northern England. We suggest that the language used in this particular specialty is often confusing and misunderstood by the families involved. We found that unfamiliar terms may also conjure up also conjure up alarming images. It is important therefore, that physicians, and in particular geneticists, try to use simple, understandable language, and give clear explanations for unfamiliar terms that cannot be avoided. The careful choice of words, and detailed explanation, not only reduces the risks of "labelling" and stigmatization, but may also prevent the unnecessary anxiety experienced by patients when they hear unfamiliar medical terms, such as the eponyms frequently employed by geneticists when giving a diagnosis.

Tracking skin integrity: a template for hospital and vendor collaboration.

Collaborative endeavors are particularly attractive in a time when resources are under extensive demand, but for organizations to be successful at collaboration, many shared values and qualities are necessary. In 1992, a hospital and a vendor of therapeutic bed surfaces entered into a collaborative partnership to test clinical indicator ability to track skin care outcomes. The vendor contributed major funding for the project, a national database from which clinical indicators on pressure ulcers were determined, and data processing and analysis. The hospital provided project coordination, clinical knowledge, data collectors, and access to patients. The article describes the process, problems, and benefits of collaboration and underscores the need for a trusting psychological climate, strong mutual interest in the project, clearly stated goals with resources to meet them, collaborator consideration of each other as peers, and skill in tension management if collaboration is to be successful.

How do desk-top computers affect the doctor-patient interaction?

General practice consultations were video-recorded before and after the introduction of a desk-top computer system into the practice. The recordings were analysed by detailed qualitative scrutiny of tape and transcripts (conversation analysis) to discover regular patterns of interaction. This analysis confirmed that the introduction of computers into the consultation had a significant impact on the communication between patient and doctor. In particular, we found that computer technology has had an impact on the practitioners' conduct and on the disclosure of information by the patient. The analysis also points to some recommendations both for training general practitioners in the use of computerized systems in the consultation, and for the (re)design of the technologies themselves.

Parental guilt: The part played by the clinical geneticist.

Parents of children born with a disability often suffer feelings of inappropriate guilt and shame. Although some genetic counselors see their main task to be that of diagnosis and education, they also aim to relieve these feelings of guilt and shame. Little is known about the process of genetic counseling, and whether or not counselors achieve this aim. An exploratory study of one clinic, and one geneticist working with 30 families, using video recordings and taped interviews, indicated that this particular doctor sometimes succeeded in reducing guilt, either intentionally or unintentionally, but on one occasion guilt was iatrogenic, and increased rather than decreased. Further research is needed to examine other types and other styles of genetic counseling so that in future iatrogenic guilt can be avoided, and the distressing aspects of inappropriate guilt and shame reduced as much as possible.

Evaluation of a mass media campaign on smoking and pregnancy.

Two surveys were conducted among pregnant women throughout England, before (n = 625) and after (n = 607) a mass media campaign on smoking and pregnancy targeted at women aged 15-24 years, in the social grade C2DE. The majority of the post-campaign sample recalled having seen at least one of the campaign's series of press advertisements. There was a significant increase among this sample in those considering smoking to be very dangerous to the unborn child, in those understanding the term passive smoking and in those considering passive smoking to be very dangerous. During the campaign there was a 14% increase in the number of calls to a cessation helpline from pregnant women. Over the campaign there were no significant changes in smoking prevalence and consumption among pregnant women or partners or in the numbers of partners offering suggestions to pregnant women about their smoking behaviour.

Exploration of doctor and patient agendas in general practice consultations.

A method for the interactional analysis of doctor/patient consultations is described and applied to six naturally occurring general practice interviews by three raters. The method is reliable given sufficient training and satisfies the stringent criteria for any method of analysis for medical interviews proposed by Wasserman and Inui [1: Wasserman R.C. and Inui R.S. Med. Care 21, 279, 1983].