Biomedical subjects
C Wilkinson
Publications and source records attributed to C Wilkinson.
Abnormal cervical smear test results: old dilemmas and new directions.
Primary care professionals play a major role in the cervical screening programme in the United Kingdom, especially since the new contract for general practitioners. Many aspects of the programme are still the subject of broad debate and detailed research. New policies regarding the programme are generated at various levels; feedback is not always made directly available to primary care teams. This review article attempts to summarize the current available literature on cervical screening, focusing on the meaning of minor degrees of dysplasia, cervical cancer in younger women, the role of the wart virus, frequency of smear tests, diagnosis and treatment, counselling, and concludes with practical advice to help the practice team.
Set menus and clinical freedom.
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Twin pregnancy in a patient with idiopathic long QT syndrome. Case report.
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Postoperative joint replacement pain: description and opioid requirement.
The present research was designed to describe the character, severity, and factors associated with postoperative pain following total hip replacement (THR) and total knee replacement (TKR) surgery, and to identify amounts of opioid required to relieve that pain. It was the investigators' intention to investigate the impact of age on severity of pain and amount of opioid required after surgery. Complete data were obtained on 29 white subjects, 16 of whom were men. Subjects' ages ranged from 27 to 88 years (mean, 66). The mean age for the men was 61 years and the mean age for the women was 72 years. Twelve subjects underwent THR and 17 underwent TKR. Eight patients received general anesthesia and 21 received spinal anesthesia. Pain was described using the McGill Pain Questionnaire-Short Form and quantified using a visual analogue scale. Amount of opioid required to relieve pain over 24 hours was recorded using a patient-controlled analgesia pump. Data analysis indicated that most patients do not report their pain as being controlled when discharged from the PACU, and that patients who receive spinal anesthesia require more postoperative opioid to control pain than patients who receive general anesthesia. In general, patients who undergo TKR experience more pain than patients who undergo THR. Pain was described as moderate to severe aching. As age increases, patients self-administer less postoperative opioid, but they do not report less postoperative pain.
Effect of a general practitioner's consulting style.
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Anxiety caused by abnormal result of cervical smear test: a controlled trial.
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Management of asthma in the community.
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General practitioners' attitudes towards AIDS.
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Time to let the patient speak.
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Filtering effects in reporting work injuries.
Research efforts in the field of occupational injuries have been hampered by difficulties in ascertaining true prevalence rates. Lack of accuracy in reporting and documentation of work injuries leads to loss of information and lack of comparability of work injury statistics. The paper explores some of the factors related to loss of information about work injuries and proposes a descriptive model of the information processing system. The Filter Model describes the way in which information about a given injury proceeds through a series of levels, from true prevalence of injuries in the workplace, to prevalence as indicated by national aggregate statistics. Between each level is a "filter" or barrier that is selectively permeable, ensuring that information about some, but not all, injuries will pass through to the next level. Consequently, the type of work injury data collected at each level will differ. The Filter Model can aid in choice of appropriate level of data for research purposes, and provides a framework for investigation into the nature and extent of filtering processes within work injury reporting systems.
Managing drug use.
This study of Class A drug users in Nottingham identifies a local drug economy with specific demand and supply characteristics. With reference to demand, data are presented on users' purchasing power and purchasing behaviour, including drug re-sales and the use of credit. Crude elasticity relationships are discussed. The analysis of the supply side includes an examination of the dealing system and pricing methods. Following the integration of these two themes by way of summary the paper concludes with a discussion of the implication of its findings for public policy aimed at managing drug use.
Class A drug users: prevalence and characteristics in greater Nottingham.
This paper reports on the prevalence of known Class A drug use in Greater Nottingham, a large urbanized area with a population of 472,285 in 1981. Use of a multi-agency enumeration technique identified only 170 users during 1985-86, giving an annual prevalence of 0.45 per 1000 of the adult population. The rates for opioid use and injected amphetamine use were 0.27 and 0.14 per 1000. Geographical analysis of the intra-urban residential distributions of the drug users identified statistically significant variations with the greatest concentrations occurring in the inner city residential areas, in neighbourhoods fringing major suburban shopping centres, and several council estates. Ecological analysis established statistically significant links between drug use and multiple deprivation, adult unemployment and crime.
Is the treatment of scabies hazardous?
Treatment for scabies is usually initiated by general practitioners; most consider lindane (gamma benzene hexachloride) the treatment of choice. Lindane is also widely used as an agricultural and industrial pesticide, and as a result the toxic profile of this insecticide is well understood. Evidence is accumulating that lindane can be toxic to the central nervous system and may be associated with aplastic anaemia. Preparations containing lindane continue to be sold over the counter and may represent a hazard to poorly informed patients. This literature review suggests that general practitioners should prescribe scabicides with increased caution for certain at-risk groups, and give adequate warnings regarding potential toxicity.
Beta-adrenergic blockade restores glucose's antiketogenic activity after exercise in carbohydrate-depleted athletes.
1. The development of post-exercise ketosis is not abolished by the ingestion of glucose immediately after exercise, despite inducing high insulin/glucagon ratios in the peripheral (and therefore by implication in the portal) blood. 2. To investigate the possibility of autonomic control of the liver influencing its sensitivity to the major counter-regulatory hormones, we administered 50 g glucose, either on its own, or together with 0.5 mg prazosine, 40 mg propranolol, or 15 mg propantheline, to forty-seven 48 h carbohydrate-starved athletes who had just run 25 km. 3. The blood 3-hydroxybutyrate concentration rose from 0.30 +/- 0.05 (mean +/- S.E. of mean) to 0.52 +/- 0.08 mmol/l with exercise, and then to 1.32 +/- 0.40 mmol/l at 6 h after exercise in subjects who had ingested only glucose after exercise. 4. The effects of prazosine and propantheline on the blood ketone body concentration at 2 h after exercise was not statistically significant. Propranolol, on the other hand, significantly lowered the blood 3-hydroxybutyrate concentration (compared with controls) to 0.09 +/- 0.03 mmol/l at 3 h (P less than 0.01), and 0.35 +/- 0.08 mmol/l at 6 h (P less than 0.01) after exercise. 5. The plasma insulin, glucagon, glucose and free fatty acid concentrations were unaffected by propranolol, indicating that the antiketogenesis was the result of a direct effect on ketone body metabolism. 6. Since beta-adrenergic blockade has not previously been shown to have antiketogenic activity, except in somatostatin-induced hyperketonaemia, it is concluded that its effectiveness in post-exercise ketosis can probably be ascribed to a functional hepatic insulin and glucagon deficiency.
Agreement between two measures of alcohol consumption.
Responses on the Quantity-Frequency Questionnaire (QF) were compared with those on the self-report diary. The QF was administered to 778 general practice patients prior to their consultation and the same patients completed the diary at home within 24 hours. The diary overestimated the number of nondrinkers in the population relative to the QF and classified a higher proportion of patients as heavy drinkers. The QF failed to detect 78% of heavy drinkers identified by the diary. Significantly (p less than .001) more alcohol was reported to be consumed overall on the diary (mean, 10.51 drinks/week) than on the QF (mean, 6.87 drinks/week). The relationship between responses on the two measures was nonlinear. At low consumption levels patients indicated drinking twice as much on the diary as on the QF, but the magnitude of the reported consumption difference decreased with increasing consumption levels. The results are discussed in terms of their implications for self-report measures of alcohol consumption.
The locus of inhibition of NADH oxidation by benzothiadiazoles in beef heart submitochondrial particles.
6-Chloro-1,2,3-benzothiadiazole (6-Cl-BTD) is an effective inhibitor of NADH oxidase (site I) but not of succinate oxidase in beef heart submitochondrial particles. For NADH oxidase activity maximal inhibition (80-85%) was achieved at 0.75mM 6-Cl-BTD. A similar level of inhibition was also observed (half maximal inhibitory concentration 0.5mM) towards NADH-duroquinone reductase; NADH-juglone reductase was slightly inhibited (23%) at 0.5mM 6-Cl-BTD while NADH-ferricyanide reductase was unaffected. The data suggest that 6-Cl-BTD interacts with an electron transport site on the oxygen side of NADH dehydrogenase and inhibitory studies with 6-Cl-BTD and rotenone indicate that it might correspond with one of the two sites affected by rotenone. The substituted 1,2,3-benzothiadiazoles (BTDs) are perhaps best known for their activity as inhibitors of cytochrome P-450-mediated mixed-function oxidation (MFO). In vitro, the BTDs are potent inhibitors of MFO activities in microsomes from mammalian liver and insect tissues and they have been demonstrated to inhibit aminopyrine metabolism in perfused rat liver. In vivo, they reportedly prolong hexobarbital sleeping time in mice, inhibit the irreversible binding of labeled trichloro-ethylene to microsomal protein and effectively enhance the toxicity (synergize) of pyrethrin, organophosphorus-containing and carbamate insecticides to insects.
High voltage electric injury.
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