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Biomedical subjects

C MacArthur

Publications and source records attributed to C MacArthur.

At least 37 records · Page 2Linked to original sources
PubMed1996

Anaesthetic characteristics and long-term backache after obstetric epidural anaesthesia.

Anaesthetic casenotes of 4700 women who had epidural anaesthesia for deliveries between 1978-1985 were examined to look for associations between various epidural characteristics and subsequently reported long-term backache. The data on long-term backache came from a postal questionnaire sent to the women. The only clear predictor of the occurrence of long-term backache was having experienced backache immediately after the birth whilst still in hospital. There were no relationships between long-term backache and the duration of the epidural or various indicators of the extent of motor or sensory block. Within the range of local anaesthetic concentration levels used in this series, the extent of block did not seem to affect backache, but the effect of minimal motor block with corresponding increased mobility, such as is available with low concentration anaesthetics mixed with opiates, merits further study.

Journal Article↗
PubMed1996

Accessibility of genitourinary medicine clinics.

OBJECTIVES: to examine and compare the accessibility and acceptability of a range of genitourinary medicine (GUM) clinics. DESIGN: five GUM clinics representing different types of locations in the West Midlands Region were selected. All patients attending over the sampling period were included, with data collected by anonymous self completed questionnaire. RESULTS: 297 completed questionnaires were obtained from 360 attendees; 87.4% of attendees had taken 30 minutes or less to get to the clinic, and 66% had used public transport, with variations found between locations. The majority (72.5%) of attendees visited the clinics during their preferred part of the day. Examination of narrower time preferences showed that those wanting to visit in the evening were less likely to be seen during their preferred time than those wanting daytime visits (32% compared with 90%). Of the attendees 98.6% found clinic staff to be friendly and 97.5% did not feel they were being judged because of their sexual activities. The most common reasons for choosing a clinic were recommendation (38.2%) and proximity (36.4%). CONCLUSIONS: the clinics were generally found to be physically accessible, although clinic opening hours need to be reconsidered. Further work is needed on the acceptability of the service in relation to expectations.

Ambulatory Care Facilities↗
PubMed1996

A comparison of HIV related advice in genitourinary medicine clinics with different histories.

OBJECTIVES: To examine attendees reported experiences of health advice provision in genitourinary (GUM) clinics with different histories. DESIGN: A self-completed anonymous questionnaire was distributed at five clinics in the West Midlands Region of the United Kingdom. RESULTS: 297 of the 360 attendees approached returned completed questionnaires; 89.5% reported receiving health advice, 86.4% found all of this easy to understand and 10.4% wanted more advice. However, 33.9% received no advice on either HIV or safer sex. Those attending new clinics, set up since the HIV pandemic, were more likely than those attending older clinics, to have understood the advice given, to have had advice on both HIV and safer sex, and less likely to have wanted more advice. Among those attending with a concern about HIV, 14% claimed to have received no advice on either HIV or safer sex; with no difference between old and new clinics. For those attending with reasons particularly relevant to receiving HIV related advice, but not with a concern about HIV, 40% claimed to have received neither HIV nor safer sex advice. In this sub-sample, those attending new clinics were more likely to have received advice on HIV as well as safer sex, and less likely to want more advice. CONCLUSIONS: The results indicate that the provision of advice needs to be reconsidered, particularly in older clinics.

Adult↗
PubMed1995

Attendance, content and relevance of the six week postnatal examination.

OBJECTIVE: to describe the attendance and content of the six week postnatal examination, and associate the examinations performed with relevant delivery factors and postpartum symptoms. DESIGN: survey of 1278 women who responded to a postal questionnaire sent 6-7 months after delivery, as part of a wider study investigating the severity, effect and extent of long-term health problems after childbirth. Questions about attendance and content of the postnatal examination were included. Data obtained from the women were linked to the obstetric case notes. SETTING: a large maternity hospital in Birmingham. PARTICIPANTS: all women who had delivered between April and September 1992, except for those who had had a neonatal death and, due to lack of funding for translators, Asian women. FINDINGS: the majority of women (91%) attended for their postnatal examination and 93% of these had an abdominal and 70% a vaginal examination. Women who had a vaginal delivery and perineal trauma were significantly more likely to have a vaginal examination but still over two-thirds of those with an intact perineum and almost half delivered by elective caesarean section also had this. Only 16% of women had a blood test. Those who had a PPH, a low third day Hb or reported a new postpartum onset of fatigue were more likely to have a blood test, but three-quarters of the women with these risk factors did not have blood taken. DISCUSSION AND CONCLUSION: women are prepared to attend for postnatal assessment but many have examinations without obvious reason, whilst other tests which might be helpful for certain conditions are infrequently used. Substantial postpartum morbidity is known to exist and this is not routinely assessed at the postnatal assessment. IMPLICATIONS FOR PRACTICE: the present six week postnatal examination does not appear to meet the health needs of women after childbirth: its content and timing should be reviewed.

Female↗
PubMed1994

Identifying morbidity in postpartum women.

Women with postpartum health problems do not readily initiate consultation, making it necessary for those providing care to devise methods by which problems can be identified. By taking detailed accounts of each woman's labour and delivery details when planning postpartum care, some morbidity could be preempted and its effect limited. Postnatal care requires a planned structure which could be modelled on current antenatal care organisation. All women could routinely be seen at three or six months post-delivery. Care could be given by midwives, with referral to GPs where necessary. Fatigue could put women at greater risk of developing postpartum depression, but few women spontaneously report fatigue as a health problem. Limiting the effects of childbirth on maternal health will have important implications for the future use of the medical services.

Female↗
PubMed1994

Changing patterns in pediatric supraglottitis: a multi-institutional review, 1980 to 1992.

Supraglottitis is a rapidly progressive, life-threatening airway emergency in pediatric patients typically caused by Haemophilus influenzae type B (HIB). With distribution of the first efficacious vaccine for HIB in April 1985, changing disease patterns have begun to emerge; however, certain characteristics have remarkably persisted. The authors reviewed 252 pediatric patients with acute supraglottitis spanning the prevaccination and postvaccination years 1980 to 1992 at three major regional pediatric hospitals in Massachusetts, Ohio, and California, as well as at two community hospitals in Massachusetts. Findings include a decline in disease prevalence in all geographic areas with demographic, etiologic, and management evolution all seen. Children who had been immunized yet developed supraglottitis have been examined as predictive of future trends.

Age Factors↗
PubMed1993

Accidental dural puncture in obstetric patients and long term symptoms.

OBJECTIVE: To examine the association between accidental dural puncture and long term headache and related symptoms. DESIGN: Postal questionnaire survey to elucidate new symptoms occurring after childbirth, and linking of these to data in obstetric and anaesthetic case notes. Women were surveyed between 13 months and nine years after delivery. SETTING: Birmingham Maternity Hospital. SUBJECTS: 4700 women who had delivered their most recent baby under epidural anaesthesia, 74 of whom had suffered an accidental dural puncture. MAIN OUTCOME MEASURES: Frequencies of new headache or migraine or neck ache starting within three months after childbirth and lasting over six weeks. RESULTS: Among the 74 women who had had an accidental dural puncture there were 17 (23%) who reported one or more of the above symptoms. By comparison, among those who had had an epidural anaesthetic but no recorded puncture, only 329 (7.1%) reported these symptoms. The duration of the headache or migraine or neck ache in the dural tap group ranged from nine weeks to over eight years. Ten of these women reported still unresolved symptoms. CONCLUSIONS: Conclusions on causality were tentative. Most women would remember a dural tap, and this might influence their reporting of subsequent symptoms attributable to the event. In addition, detailed characterisation of the symptoms was not available. Nevertheless, the findings provide a clear indication of the need for further study of the possible long term sequelae of accidental dural puncture.

Accidents↗
PubMed1993

Evaluation of obstetric analgesia and anaesthesia: long-term maternal recollections.

Opinions about pain relief were sought from a sample of 11,701 women 13 months to 9 years after giving birth. Their opinions related both to levels of satisfaction with the particular forms of pain relief used and to the presence of any feelings of deprivation of the birth process. Of all forms of pain relief examined epidural anaesthesia was associated with the highest levels of satisfaction. In vaginal deliveries, 69.4% of those who had an epidural were fully satisfied, compared with 29.5% for inhalation analgesia, 20.7% for pethidine and 29.4% for relaxation techniques. Women who had spontaneous deliveries and shorter labours were least satisfied with their epidurals, while the reverse was generally true for the other forms of pain relief. After an epidural for vaginal delivery 7.1% of women reported feelings of deprivation of the full pleasure of childbirth. This was higher than the 1.4% previously reported by women in the same maternity unit when questioned immediately after the delivery,(1) but still only represents a minority of women. After an emergency caesarean section administered under epidural feelings of deprivation were expressed by 5.1%, but by only 1.7% after an elective section under epidural. Among women using pethidine 3.5% felt that this had deprived them of the pleasure of giving birth.

Journal Article↗
PubMed1993

Comparison of long-term health problems following childbirth among Asian and Caucasian mothers.

While obstetric problems in Asian women have been documented, little is known about longer term health problems following childbirth. This study compares long-term postpartum morbidity in Asian and Caucasian women who had had an infant at a Birmingham maternity unit between 1978 and 1985. A total of 11,701 women returned the questionnaire asking about their experience of a list of 25 health problems. It was found that backache, frequent headaches, shoulderache and pains and weakness in the arms and legs all occurred more commonly among the 530 Asian women than in Caucasian women, even after standardizing for confounding factors. All these symptoms started within three months of the birth, lasted more than six weeks and had not previously been experienced. Most symptoms persisted for more than a year, and even after several years, many had not resolved. The possible role of vitamin D deficiency and the value of antenatal vitamin D supplements are discussed.

Adult↗
PubMed1992

Investigation of long term problems after obstetric epidural anaesthesia.

OBJECTIVE: To examine the association between obstetric epidural anaesthesia and subsequent long term problems. DESIGN: Postal questionnaire on health problems after childbirth linked to maternity case note data. SETTING: Maternity hospital in Birmingham. SUBJECTS: 11701 women who delivered their most recent child during 1978-85 and who returned completed questionnaires. MAIN OUTCOME MEASURES: Frequencies of long term symptoms after childbirth. RESULTS: Compared with the 6935 women who did not have epidural anaesthesia the 4766 women who did more commonly experienced backache (903 (18.9%) with epidural v 731 (10.5%) without epidural), frequent headaches 220 (4.6%) v 199 (2.9%)), migraine (92 (1.9%) v 73 (1.1%)), neckache (116 (2.4%) v 112 (1.6%)), and tingling in hands or fingers (143 (3.0%) v 150 (2.2%)). The results could not be explained by correlated social or obstetric factors. The associations with head, neck, and hand symptoms were found only in women who reported backache. An excess of visual disturbances among women who had epidural anaesthesia (83 (1.7%) v 91 (1.3%)) was present only in association with migraine, but excess of dizziness or fainting (102 (2.1%) v 109 (1.6%)) was independent of other symptoms. 26 women had numbness or tingling in the lower back, buttocks, and leg, of whom 23 had had epidural anaesthesia. Of 34 women with spinal headache, nine (five after accidental dural puncture; four after spinal block) reported long term headaches. CONCLUSIONS: These associations may indicate a causal sequence, although this cannot be proved from this type of study. Randomised trials of epidural anaesthesia are required to determine whether causal relations exist.

Adult↗
PubMed1992

Improving the compositions of students with learning disabilities using a strategy involving product and process goal setting.

This study was conducted to determine if a planning and writing strategy would improve the essay writing of students with learning disabilities. Four participants were taught a strategy designed to facilitate the setting of product and process goals, generation and organization of notes, continued planning during writing, and evaluation of goal attainment. Training effects were investigated using a multiple probe design across subjects. Strategy instruction had a positive effect on students' essay writing performance and knowledge of the writing process, and effects were maintained over time.

Achievement↗
PubMed1991

Synthesis and secretion of high- and low-molecular-weight forms of the enzyme-releasing peptide (ERP) from the macrophage-like cell line THP-1.

Neutrophil enzymes have been implicated as a source of lung injury in patients with the adult respiratory distress syndrome (ARDS) and with emphysema. We studied a human alveolar macrophage-derived peptide messenger, the enzyme-releasing peptide (ERP), which causes neutrophils to secrete their enzymes. The secretion and synthesis of ERP was studied in human alveolar macrophages and in the macrophage-like cell lines THP-1, HL-60, and U937. All four cell types secrete an ERP-like peptide. THP-1 cells secrete a higher concentration of the peptide than do macrophages. The secretion of ERP by THP-1 is suppressed by the protein synthesis inhibitors actinomycin D and cycloheximide. While the macrophages secrete ERP, they do not synthesize it. These studies suggest that ERP is synthesized by an alveolar macrophage precursor and stored in the mature macrophage for later release. 12-O-tetradecanoylphorbol-13-acetate (TPA) suppresses ERP secretion by THP-1 cells, but it does not modify secretion in macrophages. Escherichia coli-derived lipopolysaccharide and dimethyl sulfoxide do not modify secretion in either cell type. The THP-1 cells secrete a high- and low-mass-ratio (Mr) form of ERP-like proteins. The low Mr but not the high Mr form stimulates neutrophils to secrete their granule enzymes. We conclude that human alveolar macrophages secrete ERP but do not synthesize it. It is likely that ERP is made by an alveolar macrophage precursor in a high Mr form that is cleaved prior to secretion by the macrophages.

Antibodies, Monoclonal↗
PubMed1990

Epidural anaesthesia and long term backache after childbirth.

OBJECTIVE: To examine the relation between epidural anaesthesia and long term backache after childbirth. DESIGN: Data from postal questionnaire on morbidity after childbirth sent to women who had delivered in one maternity hospital between 1978 and 1985 were linked to maternity case notes for each woman. SETTING: Maternity hospital in Birmingham. SUBJECTS: 11,701 Women who had delivered their most recent baby at the maternity hospital during the defined period and who returned their completed questionnaires. MAIN OUTCOME MEASURES AND RESULTS: Of the 1634 women who reported backache, 1132 (69%) had had it for over a year. A significant association was found between backache and epidural anaesthesia (relative risk = 1.8); 903 of 4766 women (18.9%) who had had epidural anaesthesia reported this symptom, compared with 731 of the 6935 women (10.5%) who had not had epidural anaesthesia. This association was consistent in both "normal" and "abnormal" deliveries, the only exception being after an elective caesarean section when no excess backache occurred after epidural anaesthesia. CONCLUSIONS: The relation between backache and epidural anaesthesia is probably causal. It seems to result from a combination of effective analgesia and stressed posture during labour. Further investigations on the mechanisms causing backache after epidural anaesthesia are required.

Anesthesia, Epidural↗
PubMed1990

Misoprostol provides a colonic mucosal protective effect during acetic acid-induced colitis in rats.

This study determined if intracolonically applied prostaglandin E1 analogue (misoprostol) had a mucosal protective effect in rats with 4% acetic acid-induced colitis. The effects of misoprostol were compared with those of 5-aminosalicylic acid and betamethasone. A single application of 4% acetic acid induced an experimental colitis which was maximal at 2 days and showed spontaneous macroscopic and histologic healing by 12 days. Misoprostol (100 micrograms/kg), but not 5-aminosalicylic acid or betamethasone, administered 30 min before induction of colitis, provided macroscopic and histologic colonic mucosal protection but not protection of in vivo fluid absorption. The mucosal protective effect of misoprostol was time, dose, and diluent volume dependent. In the presence of misoprostol-induced colonic morphologic but not functional absorptive mucosal protection, in vitro unidirectional sodium and chloride flux measurements showed protection of theophylline-stimulated chloride secretion but not sodium absorption. Protection of in vivo colonic fluid absorption, in addition to morphologic protection, could be achieved when misoprostol was administered between 2 and 16 min before induction of colitis or when the highest dose (1000 micrograms/kg) of misoprostol was examined. We conclude that intracolonic misoprostol administration provides unique mucosal protective effects in experimental colitis.

Acetates↗