Evaluation of a nurse-run hypertension clinic in general practice.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
D Jewell
Publications and source records attributed to D Jewell.
Learning through examinations: use of an objective structured clinical examination as a teaching method in general practice.
An objective structured clinical examination was written to evaluate the primary care teaching in Southampton medical school's third year curriculum. Its transition from a summative to a formative evaluation is described. During the academic year 1985-86 the examination was completed by 115 students in 12 groups, and the results give some support to its validity. Students reported that they had learnt from the exercise and the reasons for this are discussed.
Achievement↗
Chronic inflammatory bowel disease, cigarette smoking, and use of oral contraceptives: findings in a large cohort study of women of childbearing age.
Since the start in 1968 of the Oxford Family Planning Association contraceptive study 31 women have developed ulcerative colitis and 18 have developed Crohn's disease, giving incidences of 0.15 and 0.09/1000 woman years respectively. The incidence of ulcerative colitis in women who were non-smokers on entry to the study was 0.17/1000 woman years and the incidence in smokers was 0.11/1000 woman years. The findings for Crohn's disease were entirely different, the corresponding incidences being 0.05 and 0.17/1000 woman years respectively. Both ulcerative colitis and Crohn's disease were more common among women currently using oral contraceptives than among those not doing so. Incidences per 1000 woman years for ulcerative colitis were 0.26 in users and 0.11 in non-users; for Crohn's disease the incidences were 0.13 and 0.07 respectively. Though the association between the use of oral contraceptives and chronic inflammatory bowel disease cannot be regarded as established, the effects of smoking have been shown consistently in many studies. This observation provides an important clue to the aetiology of chronic inflammatory bowel disease.
Adult↗
Common childhood problems: variation in management.
A patient management questionnaire was written to assess the range of advice being offered to parents on common paediatric problems. It was sent to hospital doctors, clinical medical officers, health visitors, and general practitioner trainers and trainees. In the 95 completed questionnaires just over half the items elicited conflicting advice, and some differences between different professional groups could be identified. It is suggested that such conflicts are potentially damaging to relationships between patients and health care professionals and that there are ways to avoid conflict.
Child↗
GP obstetrics: safe but endangered.
Explore the source record for details and available documents.
Choice Behavior↗
Immunocytochemical studies of blood group A, H, I, and i antigens in gastric mucosae of infants with normal gastric histology and of patients with gastric carcinoma and chronic benign peptic ulceration.
Indirect immunofluorescence studies of blood group A, H, I, and i antigens were performed on the gastric mucosae and tumor tissues of patients with gastric carcinoma, on the mucosae of patients with chronic benign gastric ulceration, and on the mucosae of infants who had died of causes other than gastrointestinal disease. The following findings were of particular interest: (1) Normal 'secretor' type mucosae were distinguishable from 'non-secretor' type mucosae by the uniform staining of the A or H antigens at the surface and in the pits. Normal 'non-secretor' type mucosae showed little staining of the H or A antigens but, instead, there was staining with anti-I(Ma) antibody. Staining with anti-I(Step) and anti-i(Den) did not show a clear correlation with the 'secretor'/'non-secretor' status of the normal mucosae. (2) Apparently normal areas of gastric mucosae of patients with gastric carcinoma or the normal part of gastric mucosae of patients with benign gastric ulcer frequently showed focal areas of loss or gain of the blood group antigens as is often seen in gastric carcinoma tissues. (3) In the mucosae of patients with intestinal metaplasia there was marked loss of A/H antigens in 'secretors' and I(Ma) antigen in 'non-secretors'. (4) Staining characteristics of tissues from gastric carcinoma were:(a) Focal loss of the expected A/H or I antigens was observed with much variation in staining from area to area, but only a minority showed complete loss of the expected staining. (b) A majority of the carcinomas from 'secretors' showed foci of substantial staining with anti-I(Ma) in contrast to normal 'secretor' mucosae. This is probably due to incomplete biosynthesis of A/H determinants. (c) Incompatible A-like staining by a rabbit anti-A serum was observed in one out of nine adenocarcinomas from blood group B or O persons. (d) A few cases showed substantial i antigen staining. The aberrant expression of blood group A, H, I, and i antigens in neoplastic as well as in some areas of morphologically normal mucosa of patients with benign and malignant diseases of the stomach is discussed in the context of current biochemical knowledge.
ABO Blood-Group System↗
Comparison of gastric emptying times in healthy cats simultaneously evaluated with radiopaque markers and nuclear scintigraphy.
Gastric emptying in 18 healthy cats was assessed simultaneously using scintigraphy and barium-impregnated polyethylene spheres (BIPS). Canned Prescription Diet Feline c/d (Hill's Pet Nutrition, Inc., Topeka, KS) labeled with 99mTc-disofenin (Hepatolite, DuPont Merck Pharmaceutical Co., Billerica, Mass.) was fed on four separate days. Scintigraphic images were obtained at time 0 and then every 30 minutes to 6 hours. On the fourth scan day, 30 small (1.5 mm) and 10 large (5 mm) BIPS (Chemstock Animal Health Ltd., Christchurch, New Zealand) were mixed with the labeled meal, and in addition to scintigraphy, radiographs were made at 60-minute intervals for 6 hours. Gastric emptying was 11 to 15% slower on the day of simultaneous radiography as compared with the 3 days when only scintigraphy was performed (p < or = .05). Percentage retention of 1.5 mm BIPS in the stomach was significantly greater than the percentage retained gastric activity at hours 1, 2, 3, 4, 5, and 6 (p < or = .05). BIPS were clustered in the pyloric region of the stomach by 3 hours in all cats. In 10/18 animals, all BIPS were retained in pyloric region of the stomach at 6 hours, despite observable decreased size of the gastric silhouette and < or =15% retained gastric activity. In conclusion, gastric emptying of 1.5-mm BIPS does not parallel gastric emptying of 99mTc-disofenin labeled canned Prescription Diet Feline c/d. Stress associated with radiography may delay gastric emptying. Diet type should be considered when evaluating clinical radiographic studies where BIPS have been used.
Animals↗
I do not love thee Mr Fell....
Explore the source record for details and available documents.
Family Practice↗
Genetics of inflammatory bowel disease. A personal view on progress and prospects.
Clinical, epidemiological and molecular data reported in the last 5 years have provided strong evidence that genetic factors are important in susceptibility to both Crohn's disease and ulcerative colitis. The model of disease inheritance which best fits the epidemiological data is that Crohn's disease and ulcerative colitis are related polygenic diseases. However, genetic heterogeneity is likely to be extensive, and may well underlie the variability in clinical presentation associated with inflammatory bowel disease. Considerable progress has already been made in identifying potential disease susceptibility loci using the technique of genome-wide scanning. There is optimism that international collaborative studies will allow fine mapping of the loci implicated on chromosomes 16 and 12. The identification of novel susceptibility genes has become a realistic goal for investigators. Once this has been achieved, there are likely to be immediate clinical benefits, both in understanding disease pathophysiology, and in disease management.
Colitis, Ulcerative↗
Serum anti-Helicobacter pylori IgG antibodies and pepsinogens A and C as serological markers of chronic atrophic gastritis.
This study was designed to test the sensitivity and specificity of serum anti-Helicobacter pylori IgG antibodies and the ratio of serum pepsinogen A to pepsinogen C (PGA:PGC) in detecting chronic atrophic gastritis (CAG) and intestinal metaplasia. Parallel gastric biopsies and a serum sample were collected from a series of 87 patients aged 20-69 years attending a routine upper endoscopy clinic. The seroprevalence (> 10 micrograms IgG/ml) of anti-H. pylori antibodies was 42.7%, and of a low PGA:PGC ratio (< 1.5) was 17.7%. A positive H. pylori IgG antibody level was more sensitive than the level of PGA:PGC in diagnosing CAG (71.4% and 25.0%, respectively), moderate CAG (86.7% and 26.7%, respectively), and intestinal metaplasia (90.9% and 50.0%, respectively). Anti-H. pylori IgG antibody levels were less specific than PGA:PGC levels in diagnosing CAG (90.9% and 93.9%, respectively), moderate CAG (78.3% and 89.1%, respectively), and intestinal metaplasia (72.6% and 92.2%, respectively). A combination of anti-H. pylori antibodies and a low PGA:PGC ratio for the detection of CAG resulted in a specificity of 100%, but the sensitivity was 21.4%.
Adult↗