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Biomedical subjects

D S Grimes

Publications and source records attributed to D S Grimes.

9 recordsLinked to original sources
PubMed1990

Incidence of advanced chronic renal failure and the need for end stage renal replacement treatment.

OBJECTIVE: To determine the age related incidence of advanced chronic renal failure in two areas of England. DESIGN: Prospective study of patients newly identified as having advanced chronic renal failure within a two year period; subsequent monitoring of patients' clinical course for a further 26 months. SETTING: Devon and Blackburn. SUBJECTS: Those patients in a population of 708,997 who developed advanced chronic renal failure (serum creatinine concentration greater than 500 mumol/l) for the first time during a two year period. MAIN OUTCOME MEASURES AND RESULTS: 210 Patients (148 per million population per year) developed advanced chronic renal failure, 117 (51%) of whom were over 70. The age related incidence rose from 58 per million per year in those aged 20-49 to 588 per million per year in those aged 80 or over. Only 54% (113) of patients were referred to a nephrologist; 120 patients (57%) needed dialysis or died within three months of presenting without receiving dialysis, and 187 (89%) died or needed dialysis within three years. After those unsuitable for further treatment had been excluded, 78 patients per million population per year aged under 80 needed to start long term renal replacement treatment. CONCLUSIONS: Many patients suitable for renal replacement treatment are still not referred for nephrological opinion and are denied treatment. If the treatment rate in the United Kingdom rose from the 1988 rate of 55.1 per million per year to 78 per million per year then the number of patients receiving treatment would rise to about 800 per million. This is double the present number and has considerable but predictable resource implications for the NHS.

Adolescent↗
PubMed1978

Effect of cigarette smoking on gastric emptying.

Gastric emptying after a test meal was studied in 17 normal volunteers--10 habitual smokers and seven non-smokers. The solid component of the test meal was labelled with technetium and the liquid component with indium. After one meal the habitual smokers smoked two cigarettes. Emptying curves were produced for both technetium and indium, and the differences between curves for meals with and without cigarettes were analysed. Cigarette smoking accelerated the rate at which the liquid component of a meal left the stomach. This may be important in the pathogenesis of duodneal ulcer and the delay in healing caused by cigarette smoking.

Abdomen↗
PubMed1977

Gastric emptying of wholemeal and white bread.

We studied the rates at which solid and liquid leave the stomach after meals of wholemeal and white bread by using a double isotope technique. There was no difference in the rates at which the solid phases of the gastric contents left the stomach but liquid left the stomach significantly more rapidly with white bread than with wholemeal bread. Furthermore, the amount of liquid leaving the stomach unaccompanied and therefore unbuffered by solid was significantly greater after while bread than wholemeal bread. These findings may be of significance in the pathogenesis of duodenal ulcer and they provide a rational basis for a possible form of dietary treatment.

Animals↗
PubMed1976

Refined carbohydrate, smooth-muscle spasm and disease of the colon.

A diet high in refined carbohydrate is implicated in the aetiology of some diseases of the colon-i.e., diverticular disease, irritable bowel syndrome, ulcerative colitis, non-occlusive ischaemic colitis, and pseudomembranous colitis. It is suggested that spasm of the smooth muscle is the common pathogenetic mechanism in these colonic diseases. The strength of the spasm producing increased pressure in the colonic lumen or wall and the length of time for which the colon has been affected are believed to determine the type of disease resulting. A diet high in refined carbohydrate allows the intense muscle spasm to occur because the physical buffering effect of faecal bulk is considerably reduced.

Colitis↗
PubMed1976

Doctors and administrators. A joint experiment.

A course is described in which doctors in the training grades and health-service administration undertook a joint educational exercise to learn more about health care and the roles and interrelationships of the various professional groups. By sharing an educational enviroment, two professions which are frequently in conflict may realise each other's purpose and difficulties and perhaps work more harmoniously to a common aim.

Curriculum↗
PubMed1976

Physician participation in health service management: expectations in United States and experiences in England.

Increasing governmental regulation such as called for in PSRO and health planning legislation, pressures to contain rising costs, physician strikes, and other manifestations of change suggest that traditional hospital organization and management patterns ought to be re-examined. Moreover, as the United States moves toward a governmentally financed and regulated system, experiences in Great Britain and other nationalized systems become more pertinent to us. The 1974 major reorganization of the British National Health Service provides for considerable physician participation in management. A similar participative approach to the management of the hospitals in the United States is worthy of consideration as a way to meet increasing challenges of a governmentally financed and controlled health care system.

Community Medicine↗