PubMed Health⌕ Search

Biomedical subjects

C Melville

Publications and source records attributed to C Melville.

At least 19 recordsLinked to original sources
PubMed2006

Improving the health of people with intellectual disabilities: outcomes of a health screening programme after 1 year.

BACKGROUND: People with intellectual disabilities (IDs) have a higher level of health needs, a higher level of which is unmet, compared with the general population. Health screening can detect unmet health needs, but it is unknown whether it effects beneficial health outcomes in the longer term. People with IDs are reliant on health management by proxy and there are many potential access barriers that may prevent health needs identified at screening from subsequently being met. This study aims to determine whether health gains can be detected 1 year after a health screening programme specific to the needs of adults with IDs. METHODS: A total of 50 participants offered the health screen intervention were individually matched for gender, age and level of IDs with 50 control participants who received standard treatment only. Outcome measures after 1 year were semi-structured review of medical case notes, and semi-structured assessment with the people with IDs and their carer. RESULTS: During the 1-year period, the incidence of health need detection was more than twice as great for intervention, compared with control participants (mean number of new needs was 4.80 compared with 2.26; P < 0.001), and the level of met new health needs was greater (mean of 3.56 compared with 2.26; P = 0.001). The level of met health promotion needs was also greater (P < 0.001), and more health monitoring needs were met for intervention compared with control participants (P = 0.039). CONCLUSIONS: This is the first study to demonstrate sustained benefits in health outcomes from a clinical intervention for adults with IDs compared with standard treatment alone. Its routine implementation is feasible, and would reduce health inequalities.

Adult↗
PubMed2004

Portfolios for assessment of paediatric specialist registrars.

INTRODUCTION: In 1997 the Royal College of Paediatrics and Child Health introduced portfolios to guide and monitor the learning of specialist registrars. We studied their value for assessment. METHODS: Using Bigg's SOLO criteria we devised a marking scheme based on 6 domains of competence: clinical, communication, teaching and learning, ethics and attitudes, management and evaluation, and creation of evidence. We rated portfolios according to quality of evidence presented and expectations by year of training. We similarly assessed trainee performance in the annual record of in-training assessment (RITA) interview. Specific advice based on the results of the first portfolio assessments was circulated to all trainees, instructing them to increase the structure and decrease the bulk of portfolios. A second sample of portfolios was reviewed a year later, using similar evaluations, to determine the effects. RESULTS: A total of 76 portfolios were assessed in year 1 by a single rater; 30 portfolios were assessed in year 2 by 2 independent raters. The quality of documentation improved from year 1 to year 2 but there was no significant increase in portfolio scores. The inter-rater correlation coefficient of the portfolio assessment method was 0.52 (Cohen's kappa 0.35). The inter-rater correlation coefficient of the RITA interview was 0.71 (Cohen's kappa 0.38). There was moderate inter-assessment correlation between portfolios and RITA interviews (kappa 0.26 in year 1 and 0.29 in year 2). Generalisability analysis suggested that 5 successive ratings by a single observer or independent ratings by 4 observers on the same occasion would be needed to yield a generalisability coefficient > 0.8 for overall portfolio rating. CONCLUSIONS: This method of portfolio assessment is insufficiently reliable as a sole method for high stakes, single-instance assessment, but has a place as part of a triangulation process. Repeated portfolio assessment by paired observers would increase reliability. Longer term studies are required to establish whether portfolio assessment positively influences learner behaviour.

Clinical Competence↗
PubMed2002

Paediatric training for family doctors: principals and practice.

BACKGROUND: There is controversy as to how best to train general practitioners for the paediatric challenges they will meet in practice, in particular what should be included in training, what should be left out and how long should it last? SUBJECTS AND METHODS: All 615 general practice principals referring to 6 hospitals were surveyed (40% response rate). SETTING: West Midlands region of England. STUDY DESIGN: Postal questionnaire. STATISTICS: Quantitative and qualitative assessment of responses. Quantitative responses were analysed by hospital, decade of qualification, and duration of paediatric training. Qualitative responses were analysed using grounded theory. RESULTS: Satisfaction with training was directly related to its duration, with low levels of satisfaction for less than 6 months paediatrics, moderate levels for 6-11 months, and high levels with 12 months or more. The most important item of training was recognition of the sick child. Acute and chronic paediatrics was generally well covered. Psychosocial aspects, public health and immunisation were poorly addressed. Neonatal resuscitation and first day checks were seen as relevant, but neonatal intensive care was not. CONCLUSIONS: At least 6 months of paediatrics is necessary for GPs in training, but longer paediatric exposure further increases their satisfaction with training. GPs have a biopsychosocial rather than biomedical approach to their child patients, suggesting potential benefits from a greater emphasis on psychosocial and public health aspects at the expense of neonatal intensive care. Recognition of the sick child is essential, and acute and chronic organic illness should be covered in breadth. Possible future models for GP training in paediatrics are discussed.

Education, Medical↗
PubMed2002

Randomised trial of the effects of structuring clinic correspondence.

We performed a randomised controlled crossover trial of clinic letters. Structured letters were compared with conventional letters containing problem lists. There were 32 participants; 25 preferred the structured letter. Median rating and items identified were higher for the structured letter. Structured clinical correspondence with paragraph headings is strongly preferred and increases comprehension.

Correspondence as Topic↗
PubMed2001

Resuscitating paediatric induction: an action research approach.

OBJECTIVES: To establish teaching objectives, methods and assessment for a paediatric induction programme. DESIGN: Action research over a 2-year period. PARTICIPANTS: 88 doctors from three hospitals. MAIN OUTCOME MEASURES: These were end-of-course evaluations, using Likert scales, and free comments; independent evaluation by the West Midlands Deanery 4 months after courses, in which participating and non-participating units were compared, and summative assessment of trainees involving multiple-choice questions, a basic life-support scenario and an illness scenario. RESULTS: 88 participants attended four 3-day courses over 2 years. Mean satisfaction ratings were very high for content, personal value, and presentation. There was a significant rise in Deanery evaluation scores, compared with non-significant change in other hospitals, and there were excellent pass rates for trainees. CONCLUSIONS: Trainees strongly approve of induction with clear objectives, active teaching, and validated assessment.

Curriculum↗
PubMed1999

102T/C polymorphism of serotonin receptor type 2A gene is not associated with schizophrenia in either Chinese or British populations.

Several pieces of evidence implicate serotonin receptors in the aetiology of schizophrenia, and recently a number of studies have reported a genetic association between the 102T/C polymorphism of serotonin receptor type 2A gene and schizophrenia. Unfortunately a number of failures to replicate these positive associations in both Caucasian and Chinese populations have also been reported. We have examined the 102T/C polymorphism by PCR amplification and restriction analysis of DNA from: 202 schizophrenics and 202 controls from Shanghai; 112 schizophrenics and 224 parents from Chengdu, Cina; and 253 schizophrenics and 244 controls from the the UK. We find no evidence of association or transmission disequilibrium between the 102T/C polymorphism and schizophrenia in any of the groups we have examined. We conclude that either the original positive reports occurred by chance or any effect must be minimal, and urge caution in interpreting small positive results derived using data from different centres.

Carrier Proteins↗
PubMed1996

Early onset systemic Candida infection in extremely preterm neonates.

UNLABELLED: Classically, systemic Candida infections in preterm neonates occur at a mean age of 1 month. Over an 18-month period in a Regional Neonatal Intensive Care Unit we encountered seven cases of severe Candida infection, all in babies below 26 weeks gestation and weighing less than 0.75 kg. The median age of onset was 7 days (range 0-17), with thrombocytopenia, coagulopathy, hypotension, oedema, and skin breakdown being prominent features. CONCLUSION: The thin cutaneous barrier may contribute to early onset of systemic Candida infection in preterm infants. The characteristic skin appearance may assist early diagnosis.

Antifungal Agents↗
PubMed1996

Fatal cardiomyopathy in dystrophic epidermolysis bullosa.

Two unrelated children with autosomal recessive dystrophic epidermolysis bullosa (RDEB) developed fatal dilated cardiomyopathy. Both were malnourished and had severe growth problems. We believe that the most likely cause for the cardiomyopathy is a micronutrient deficiency, most probably selenium deficiency, since the serum selenium level was found to be reduced in the case in whom we measured this, and in 14 of 25 other children with dystrophic epidermolysis bullosa. Echocardiographic screening of 18 other patients revealed no evidence of cardiomyopathy. We recommend careful attention to nutrition, with prospective monitoring of vitamins and micronutrients including selenium and carnitine, and regular echocardiographic screening of patients with severe RDEB.

Adolescent↗
PubMed1995

Hypogammaglobulinaemia secondary to reflux oesophagitis.

A 7 year old girl referred for investigation of hypogammaglobulinaemia had hypoalbuminaemia and severe necrotising oesophagitis on oesophagogastroduodenoscopy. Nissen fundoplication resolved all clinical and laboratory abnormalities, but she remains under surveillance because of histological findings of Barrett's oesophagus. Erosive reflux oesophagitis can present with minimal localising symptoms, and hypogammaglobulinaemia and hypoalbuminaemia, presumably from protein loss.

Agammaglobulinemia↗
PubMed1994

Electrolyte disturbance with omeprazole therapy.

Omeprazole is an antagonist to the H+K+ ATPase of the gastric parietal cell. We report a case of severe electrolyte disturbance in a 5-year-old child treated with omeprazole associated with excessive urinary sodium loss, that responded completely to omeprazole withdrawal.

Child, Preschool↗
PubMed1993

Photochemically induced experimental ischemic neuropathy: a clinical, electrophysiological and immunohistochemical study.

A new experimental model of focal peripheral nerve infarction is presented. Ischemia was produced in 12 rats by intravascular thrombosis induced by the photochemical reaction of systemically injected rose bengal to the local application of light from a cold light source. Clinical, electrophysiological and immunohistochemical techniques were used to monitor the pathology and the time course of experimental ischemic neuropathy (EIN) of the sciatic nerve. Primary axonal neurofilament disintegration was detectable 4-24 h after illumination and was followed by wallerian degeneration within the first week. At 7 days, there was a secondary disruption of myelin sheaths accompanied by massive infiltration of macrophages and phagocytosis of the necrotic debris. The majority of detected macrophages were derived from circulating blood monocytes which had invaded the nerve. Two weeks after the initial lesions, degeneration had advanced without any signs of regeneration or remyelination. Electrophysiological recordings corroborate the findings of primary axonal degeneration and failure of regeneration up to 2 weeks after the lesion.

Action Potentials↗
PubMed1993

Bovine colostrum immunoglobulin concentrate for cryptosporidiosis in AIDS.

Lactobin-R is a commercial hyperimmune bovine colostrum with potent anticryptosporidial activity. It was administered to a 4 year old child with AIDS and severe diarrhoea associated with cryptosporidiosis. There was significant clinical improvement in the diarrhoea and permanent elimination of the parasite from the gut as assessed through serial jejunal biopsy and stool specimens.

AIDS-Related Opportunistic Infections↗
PubMed1991

Cerebral arteriovenous malformations in the neonate: clinical presentation, diagnosis and outcome.

We reviewed the diagnostic features and clinical outcome of 7 consecutive neonates who were diagnosed to have cerebral arteriovenous malformations. All presented with cardiac failure, and a cranial bruit was heard in 6/7 patients. There was electrocardiographic evidence of myocardial ischemia in 6 patients. The diagnosis was established at cardiac catheterization, or by cardiac and cranial ultrasound. Three patients died of heart failure before definitive treatment. Despite early intervention, three of the remaining four patients died either during or immediately after embolization or ligation of the fistula. A cerebral arteriovenous malformation is a rare cause of neonatal heart failure. Despite prompt recognition and aggressive treatment, the outlook for symptomatic neonates is poor.

Angiography↗
PubMed1985

Nebulised fenoterol compared with metered aerosol.

The effect of nebulised fenoterol was compared with that of a similar dose administered by metered aerosol in 14 children, aged 7 to 17 years with moderately severe asthma. The initial response to fenoterol delivered by metered aerosol or nebuliser was the same, but a second dose by nebuliser after a dose by metered aerosol produced maximum potential bronchodilatation which was not seen when a second dose by metered aerosol was given after that by nebuliser. Administration of a bronchodilator by nebuliser does seem advantageous in the treatment of some children.

Adolescent↗