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Biomedical subjects

D J Bain

Publications and source records attributed to D J Bain.

At least 19 recordsLinked to original sources
PubMed2000

Practice factors that influence antibiotic prescribing in general practice in Tayside.

A cohort design was used to evaluate antibiotic prescribing in relation to patient and general practice characteristics. The study included prescribing to all subjects resident in Tayside, from January to December 1994 and found 215217 antibiotic prescriptions dispensed to 118596 people. Training status of general practitioners (GPs) was found to be the characteristic most associated with prescribing. Adjusting for other GP characteristics had little effect on these results. Training practice status was the dominant factor associated with significant differences in rates of antibiotic prescribing, in class of antibiotic prescribed and in performance indicators of antibiotic prescribing.

Anti-Bacterial Agents↗
PubMed1999

Pulmonary arteriovenous malformation as a cause of severe exertional dyspnoea.

A 48-year-old woman presented to the respiratory clinic with progressive exertional dyspnoea and an abnormal chest radiograph. Examination revealed mucosal telangiectasia and pulmonary angiography confirmed the presence of two pulmonary arterial venous malformations (PAVM). After therapeutic coil embolisation, dyspnoea was markedly improved, and exercise tolerance increased. Comparison of exercise test responses before and after this therapeutic intervention provides new insights into the physiological mechanisms of exertional dyspnoea in this condition.

Arteriovenous Malformations↗
PubMed1998

Role of arteriography in the selection of patients for carotid endarterectomy.

BACKGROUND: Duplex ultrasonography is used increasingly to select patients for carotid endarterectomy. This study aims to clarify whether arteriography is still required. METHODS: A total of 272 patients in whom duplex imaging indicated significant disease of the internal carotid artery underwent arteriography and the results were compared. Regarding the arteriogram as the 'gold standard', three aspects were considered: the accuracy of duplex ultrasonography in detecting significant stenosis, the ability of duplex imaging to identify patients who should have arteriography and whether the arteriogram provided important additional information that might influence a decision to operate. RESULTS: Three patients (1 per cent) suffered a permanent neurological deficit as a result of arteriography. Of the 272 patients with significant stenosis identified by duplex ultrasonography, 241 (89 per cent) were confirmed as significant on arteriography. Duplex imaging was not able to predict accurately which arteriograms would provide useful additional information (sensitivity 59 per cent, specificity 65 per cent), whereas 89 arteriograms (33 per cent) contained information that might have influenced subsequent management. CONCLUSION: Duplex imaging is unable to detail the anatomy or determine the extent of carotid disease and may therefore lead to an inappropriate decision to perform carotid endarterectomy. Duplex imaging alone is not adequate before carotid endarterectomy.

Aged↗
PubMed1997

Factors contributing to relief of exertional breathlessness during hyperoxia in chronic airflow limitation.

The mechanisms of exertional dyspnea relief in response to supplemental oxygen (O2) in chronic airflow limitation (CAL) are not precisely known and are likely multifactorial. To explore factors contributing to the relief of dyspnea after oxygen administration, 11 patients with severe CAL (FEV1.0 = 39 +/- 3% predicted, mean +/- SEM) and mild hypoxemia (resting PaO2 = 74 +/- 2 mm Hg) breathed room air (RA) and 60% O2 during exercise at approximately 50% of their maximal incremental exercise capacity. Breathlessness ratings (Borg scale), endurance time, respiratory drive (change in mouth occlusion pressure over the first 0.1 s of inspiration, P0.1), ventilation (VE), breathing pattern, operational lung volumes, gas exchange, and metabolic parameters were compared during RA and 60% O2. PaO2 at exercise cessation during RA and 60% O2 was 65 +/- 3 mm Hg and 226 +/- 12 mm Hg, respectively (p < 0.001). With 60% O2, the mean of individual Borg/time slopes fell significantly (p < 0.05) by 23 +/- 12% and was associated with a 35 +/- 11% increase (p < 0.01) in endurance time (r = -0.64, p < 0.05). During 60% O2, slopes of P0.1 and lactate over time also fell significantly (p < 0.05), whereas delta PaCO2/time did not change significantly. At a standardized time near end-exercise, Borg, VE, and P0.1 changed during 60% O2 by -0.8 +/- 0.3 (p < 0.05), -4.1 +/- 2.0 L/min (p = 0.07), and -1.3 +/- 0.5 cm H2O/s (p < 0.05), respectively. Slopes of Borg/VE, Borg/lactate, and VE/lactate were essentially superimposable during tests on RA and O2: Borg, lactate, and VE all fell proportionally during hyperoxia. In patients with CAL and mild exercise hypoxemia, relief of exertional breathlessness during hyperoxia is explained by reduced ventilatory demand in association with reduced blood lactate levels.

Aged↗
PubMed1992

Correlates of asthma morbidity in primary care.

OBJECTIVES: To explore the morbidity of patients diagnosed as asthmatic in general practice, to examine the determinants of this morbidity, and to derive a simple morbidity screening tool for use in primary care. DESIGN: Patient interviews, lung function measurements, and data extraction from general practice case notes. SUBJECTS: 300 asthmatic patients aged 5 to 65 years randomly selected from the repeat prescribing registers of three general practices in the Southampton area. MAIN OUTCOME MEASURES: Reported morbidity using a calculated index based on three questions (Are you in a wheezy or asthmatic condition at least once per week; Have you had time off work or school in the past year because of your asthma; Do you suffer from attacks of wheezing during the night?); mean forced expiratory volume in one second and mean peak expiratory flow (over a seven day period); diurnal variation in peak flow; and the relation of the morbidity index to lung function. RESULTS: Mean forced expiratory volume in one second was 67% predicted (SD 18.4), mean peak expiratory flow was 80% predicted (SD 18.9), and mean diurnal variation was 10% (SD 7.7). 76 subjects were classified as having low morbidity, 95 medium, and 125 high. The morbidity index was significantly associated with forced expiratory volume in one second, mean peak expiratory flow rate, and diurnal variation (p less than 0.05); it was not significantly associated with inhaler technique or use of prophylaxis. CONCLUSIONS: There was a large burden of persisting morbidity across all ages of patients diagnosed as asthmatic in the three well resourced practices studied. The use of the morbidity index may help to target the asthmatic patients needing more attention by concentrating on those reporting medium to high morbidity.

Absenteeism↗
PubMed1984

Deputising services: the portsmouth experience.

An analysis of the deputising service in the city of Portsmouth showed that the workload of doctors was not excessive and there was no evidence that the number of calls was higher than in areas where no deputising service exists. Sixty seven per cent of patients were seen within one hour of requesting a call and 93% within two hours. Seven per cent of patients were admitted to hospital and 88% of these were seen within one hour of requesting medical care. Drugs were prescribed at 65% of all contacts between doctor and patient which compares favourably with prescribing rates for consultations in general practice. A notable feature of the Portsmouth scheme is that all subscribers who use the deputising service have to agree to participate as a deputy, with 90% of deputies being practising general practitioners or eligible to be principals in general practice. This has probably conserved costs and hospital resources.

Adolescent↗
PubMed1984

Practice research. Training for general practice: clinical behaviour in trainers and trainees.

A study of 20 trainers and their trainees in general practice showed that trainees had a statistically significant improvement in their diagnosis of otitis media during their trainee year and also became quicker in the time taken for history taking and examination. There was a fall in trainees' prescribing of antibiotics for otitis media during the study but this was accompanied by a notable rise in prescribing of decongestant-antihistamine mixtures to a level similar to that of the trainers. Trainees seemed to accept readily their trainers' prescribing policies and were hesitant to challenge them. An important finding was that trainees had little influence on trainers' prescribing, the latter showing no appreciable changes during the study.

Anti-Bacterial Agents↗
PubMed1981

Patient mobility and consulting behavior: a comparative study between the United Kingdom and the United States.

A study of consulting patterns of patients in the United Kingdom and the United States who had recently moved house and settled in a new environment shows that the act of moving has a notable effect on patients' health. Despite the radically different structure of the medical services in the United Kingdom and the United States, the consulting behavior of patients in contrasting settings was remarkably similar. During the first year in a new community, adults will consult twice as often as established patients with emotional illness; and during the same period of time, children will be seen twice as often with respiratory illness. The settling in period in a new environment is a time of stress, and such times of stress will be reflected by higher consulting rates and greater demand on physicians' services.

Family Practice↗
PubMed1980

Characteristics of family practitioners with large geriatric practices.

Little has been reported on the characteristics of physicians presently serving the health needs of the elderly. In this report, generated from a survey of Florida family practitioners, physicians and with large geriatric practices are compared to physicians with practices composed primarily of younger patients. Family physicians with large geriatric practices are older, and treat more chronic disease than do their peers. However, they consult the same professional journals and texts in caring for their patients, refer patients to specialists at the same rate, and have the same office facilities as do their colleagues who treat chiefly younger patients. The family physician with a large geriatric case load is less likely to have a predominantly outpatient practice and more likely to be involved with hospitalized patients. Data from the census and health manpower studies suggest that family physicians will care for substantial number of elderly patients in the future. Continuing education which addresses issues in geriatrics may help to attain optimal health care for the elderly.

Age Factors↗