PubMed Health⌕ Search

Biomedical subjects

A MacFarlane

Publications and source records attributed to A MacFarlane.

At least 19 recordsLinked to original sources
PubMed2005

Role flexibility among telemedicine service providers in the north-west and west of Ireland.

A recent review of telemedicine services in the north-west and west of Ireland identified 11 telemedicine services, most of which were in the early stages of implementation. A qualitative approach was used to review them. Semistructured interviews were conducted with a multidisciplinary group of primary- and secondary-care providers (n = 21) who were involved with either synchronous or asynchronous telemedicine services. Data were analysed according to the principles of framework analysis. Participants described the ways in which they were flexible about their workload, professional identities and roles to facilitate the organization and delivery of telemedicine services, and to ensure that services ran smoothly. While the positive effect of product champions and members of a wider supportive network or alliance on the conception and development of telemedicine services must be acknowledged, questions remain about associated long-term implementation and sustainability.

Attitude of Health Personnel↗
PubMed1997

Should patients with facial fractures be regarded as high risk for HIV?

OBJECTIVE: To determine the prevalence of HIV seropositivity in patients with facial fractures in Edinburgh, UK. DESIGN: A prospective study of 100 consecutive patients in 1994. SETTING: Department of Maxillofacial Surgery, City Hospital, Edinburgh, UK. SUBJECTS: 100 patients with facial fractures who were willing to participate in the study. MAIN OUTCOME MEASURES: Details of facial fractures. Assessment of risk factors for HIV. The seroprevalence of HIV based on unlinked anonymous testing of saliva. RESULTS: None of the participants were HIV positive on saliva testing. Nine patients were found to have one or more risk factors for HIV. Eight patients had been tested for HIV previously. CONCLUSION: Direct history taking appears to be effective in eliciting risk factors for HIV. A detailed risk factor history should be taken for all patients with facial fractures. Continuation of this study may establish whether or not there is a link between facial bone fractures and HIV seropositivity.

Adolescent↗
PubMed1996

Planning and commissioning of health services for children and young people.

BACKGROUND: Local audits in England and Wales performed in 1994 showed that child health commissioning was not being given priority. We were concerned that child health commissioning was in addition not performed in a child-centred way, with the best interests of children to the fore. METHOD: A survey of health authorities and boards was performed, to investigate child health commissioning in the United Kingdom. A questionnaire was sent to all directors of public health medicine in post in November 1994. The main outcome measures were child health experience within commissions and the context of children's services within the wider commissioning process. RESULTS: A total of 120 (92%) of 129 authorities replied. Sixty-nine (58 per cent) had a named person with responsibility for child health services, of who 7 (5 per cent) worked exclusively within this area, 42 (32 per cent) had experience within clinical child health, and 19 (15 per cent) had postgraduate qualifications in child health. One hundred and five (81 per cent) authorities replied to a question on the comprehensiveness of the commissioning process; of these, 45 (34 per cent) planned and commissioned children's services in their entirety and 60 (46 per cent) planned and commissioned children's services in the context of other service areas. A majority did not plan and commission acute and community services together. CONCLUSION: Many authorities had no named person with responsibility for a child health strategy. Of those that did, most named persons had inadequate experience and few had postgraduate qualifications in child health. Most authorities had no comprehensive planning mechanisms for children's services. In consequence, most commissions were failing to comply with the UN Convention on the Rights of the Child.

Administrative Personnel↗
PubMed1995

Labour and delivery of 'normal' primiparous women: analysis of routinely collected data.

OBJECTIVE: To ascertain whether there is variation in obstetric practice within a defined subgroup of primiparous women. DESIGN: Analysis of routinely collected data. SUBJECTS: Ten thousand two hundred and ninety-five primiparous deliveries defined as 'normal' in Scotland during 1990 and 44,820 primiparous deliveries defined as 'normal' in England between April 1990 and April 1991. RESULTS: Little variation was found in the distribution of mothers' ages and gestational ages at delivery, and babies' birthweights. In both England and Scotland there was considerable variation between regions in instrumental delivery rates and caesarean section rates. There were many deficiencies in the quality of the data provided by the English Maternity Hospital Episode System. CONCLUSIONS: There is regional variation in instrumental delivery rates and caesarean section rates in England and Scotland. The poor quality of data for England makes interpretation of the cause of variation difficult because the extent to which variation may reflect deficiencies in the data, rather than differences in practice, is unknown. Improvements need to be made in Maternity Hospital Episode system data, increasing both coverage and data quality. Nevertheless, similar variations in instrumental delivery and caesarean section rates may be associated with differences in population characteristics not measured in these data sets of differences in obstetric practice.

Adolescent↗
PubMed1992

The value of internal fixation and radiotherapy in the management of upper and lower limb bone metastases.

Fifty-four consecutive patients underwent 61 orthopaedic operations for metastatic bone disease affecting the upper and lower limbs. These patients were subsequently managed using a consistent postoperative radiotherapy (RT) policy. There were 27 prophylactic internal fixations and 34 internal fixations of pathological fractures. There was a marked difference in survival between these groups. The median postoperative survival of the prophylactic (P) group was 15 months whereas that of the fracture (F) group was 2 months (P less than 0.0001). Ninety-three per cent of the P group and 59% of the F group were able to be discharged home following treatment. Subsequent local fracture requiring further surgical intervention occurred in 11% of the P group and in none of the F group. Seventy-eight per cent of the P group and 62% of the F group did not suffer any further sequelae at the operation site until the time of death or last follow-up. Patient mobility following surgery and RT for metastatic lesions occurring in the lower limb was significantly improved in both the P group (P less than 0.05) and in the F group (P less than 0.0001) such that 91% and 58%, respectively, of these patients were subsequently able to walk.

Adult↗
PubMed1992

The Sheffield splint for controlled early mobilisation after rupture of the calcaneal tendon. A prospective, randomised comparison with plaster treatment.

Forty patients with acute complete rupture of the calcaneal tendon were managed conservatively and randomly allocated to treatment groups using either cast immobilisation for eight weeks, or cast immobilisation for three weeks, followed by controlled early mobilisation in a Sheffield splint. The splint is an ankle-foot orthosis which holds the ankle in 15 degrees of plantar flexion, but allows some movement at the metatarsophalangeal joints. It is removed to allow controlled movement during physiotherapy. Patients treated with the splint regained mobility significantly more quickly (p less than 0.001) and preferred the splint to the plaster cast. The range of dorsiflexion at the ankle improved more rapidly after treatment in the splint (p less than 0.001), and patients were able to return to normal activities sooner. Recovery of the power of plantar flexion was similar in the two treatment groups, and no patient had excessive lengthening of the tendon. One re-rupture occurred in each group.

Adult↗
PubMed1991

Possible transmission of Mycobacterium leprae in a group of UK leprosy contacts.

A case of infectious leprosy in residential accommodation in the UK prompted a study of the cellular and humoral response to Mycobacterium leprae in two groups of individuals who were in contact with the index case for almost a year. In the younger staff group (mean age 44 years) 23 of 30 individuals had positive Mitsuda skin tests, 25 showed lymphocyte transformation to a soluble sonciate of M leprae and 2 had slightly raised IgM antibody concentrations to the terminal disaccharide of M leprae phenolic glycolipid-1. In the older group of residents (mean age 83 years) 7 of 36 individuals were skin-test positive, 25 of 33 were positive by lymphocyte transformation, but none had raised antibody levels. When retested on two further occasions, the same 2 individuals in the younger group still had raised antibody concentrations, 1 of whom had a persistent lepromin skin-test response for over 8 months and showed a pronounced increase in lymphocyte transformation to mycobacterial antigens. The findings suggest that transmission of M leprae may have occurred in these 2 contacts, who were therefore given 6 months' chemoprophylaxis with rifampicin.

Adult↗
PubMed1990

Do general practitioners and health visitors like 'parent held' child health records?

The study examines the reactions of general practitioners and health visitors to parents holding the main record of their own child's health and development. From 1986 the parents in part of the Oxfordshire district were given their child's records while in the other part of the health district the records remained with the clinic. The responses to questionnaires sent out to all general practitioners and health visitors in the two areas were analysed and compared. The results show that over 90% of the general practitioners and health visitors with experience of parent held records are in favour of them, wish to continue to use them, find them to be available in the clinic and are able to use them at other times. By comparison only 59% of those general practitioners who had no experience of parent held records are in favour of such a scheme. In general this latter group show greater concern in almost all areas investigated. Thus general practitioners' and health visitors' experience of the record suggests that it is not only workable but actually desirable.

Adult↗