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Biomedical subjects

D Wingfield

Publications and source records attributed to D Wingfield.

9 recordsLinked to original sources
PubMed2005

A pilot study to assess the possible methods of determining the burden of obstructive sleep apnoea syndrome in primary care.

INTRODUCTION: A significant minority of otherwise healthy adults may suffer from disordered breathing during sleep. The commonest problem, known as Obstructive Sleep Apnoea Syndrome (OSAS), results in poor quality sleep, daytime hypersomnolence and excess risk of road traffic crashes. It is also associated with occupational injuries. OSAS can be successfully treated, reducing costs of hospitalisation. There is a gap in the literature regarding the burden of patients with OSAS in primary care, particularly because there is no agreed method for screening. OBJECTIVES: This pilot study was designed to determine the feasibility of screening for OSAS in a UK inner-city multi-ethnic primary care population, to investigate ways in which it might be detected, and to gain an awareness of the potential size of the burden of OSAS METHODS: We tested two methods of screening: firstly, postal questionnaires to a random sample of 240 patients from a subset of the population at highest risk of OSAS (men aged 35-65 years); and secondly, the same questionnaire plus two screening tools for detecting hypersomnolence, given to patients attending the practice for pre-registration health checks. RESULTS: Despite reminders, only 40% of postal questionnaires were returned and there were only 67 (28%) usable responses. The prevalence of snoring was 55%. Almost half of those patients who responded (46%) had a Body Mass Index (BMI) associated with a high risk of OSAS. This was not a positive responder bias because there were no significant differences in BMI between responders and non-responders. 12% had a collar size of greater than 17.5, whilst 34% reported daytime sleepiness, and 24% reported witnessed apnoea. Screening during pre-registration health checks proved both feasible and productive with 38 patients of differing linguistic abilities completing the assessment. CONCLUSION: Screening for OSAS in primary care by means of a postal questionnaire produced a low response. Whilst there was no evidence of a responder bias in terms of BMI, the numbers reporting large collar size, daytime sleepiness and witnessed apnoea suggest that a sizeable proportion of the population is at risk of OSAS. Questionnaires used in this study provide a means of identifying patients with symptoms suggestive of OSAS, although the sensitivity, specificity and positive predictive value of a self-administered instrument needs to be confirmed by a larger study incorporating ventilatory monitoring during sleep. The addition of screening to pre-registration health checks is feasible, but it would take a long time to screen all those at risk for OSAS by this route.

Journal Article↗
PubMed2005

Transiently elevated diastolic blood pressure is associated with a gender-dependent effect on cardiovascular risk.

We assessed the morbidity and mortality of subjects with transiently elevated diastolic pressure in the General Practice Hypertension Study Group (GPHSG) population. A total of 23 578 patients (aged 18-65 years) from seven UK general practices were screened in 1974 for a diastolic blood pressure (DBP4) of > or = 90 mmHg. Two further readings of DBP4 determined hypertensive (either DBP4 > or = 90 mmHg) or transient hypertensive (both DBP4 < 90 mmHg) status. Transients (n = 850) were matched with normotensive controls (n = 824) and risk ratios calculated over a mean follow-up of 18.7 years. Rescreening was conducted in six of the practices (n = 20 942) after 7.7 years. Male transients had a higher relative hazard for cardiovascular mortality than controls (11.8%, 8.6%, adjusted relative hazard 1.59, P = 0.056). Female transients had a lower relative hazard for cardiovascular mortality than controls (3.6%, 5.4%, adjusted relative hazard 0.39, P = 0.018). In all, 422 patients with transient hypertension were rescreened along with 367 matched controls. Significantly more transients were on antihypertensive treatment compared with their controls (odds ratio (OR) [95% CI]) for both male (4.2 [1.6-11.1]) and female patients (2.4 [1.0-5.56]) and more untreated female transients developed hypertension. Male transients had a higher rates of diabetes mellitus (adj OR = 5.1, P = 0.04) and stroke (adj OR 15.9, P = 0.03). This study has shown that transiently elevated DBP in GPHSG is associated with a significantly higher risk of later hypertension in men and women and of diabetes, stroke and cardiovascular mortality in men. Women with this condition have a significantly lower cardiovascular mortality.

Adolescent↗
PubMed2002

Selective recording in blood pressure readings may increase subsequent mortality.

BACKGROUND: Rounding blood pressure (BP) to the nearest 10 mmHg (terminal digit preference) and selecting for particular values near treatment cut-offs (number preference) have both been previously described. Both reduce measurement accuracy, and may have consequences for treatment and survival. AIM: To check for number preference in screening for hypertension, and whether this influenced subsequent mortality. DESIGN: Prospective case-control screening study. METHODS: In the General Practice Hypertensive Study Group (GPHSG), prospective case control study patients (n=23 574) were screened on one occasion for high phase-IV diastolic BP (DBP4) (> or =90 mmHg). Identified cases were matched with normotensive controls for age, sex, date of screen and ethnic group, and were registered for mortality follow-up (n=6310). Patients with a high DBP4 had two further readings, and were treated if it remained elevated. RESULTS: For DBP4 terminal digit, '0' was over-represented (28.2% vs. 20%), and the number '88' was over-represented in both men and women. There was an excess adjusted death rate for females with DBP4 88-89 mmHg vs. 90-99 mmHg for both cardiovascular (RR 2.56, 95%CI 1.43-4.56, p=0.0015) and all-cause (1.56, 95%CI 1.06-2.29, p=0.023) mortality. For males, the corresponding rates were non-significantly reduced: cardiovascular RR 0.69, 95%CI 0.42-1.14, p=0.15; all-cause RR 0.93, 95%CI 0.68-1.27, p=0.64. DISCUSSION: The quality of BP measurements should be monitored both in research studies and in clinical practice as part of clinical governance procedures.

Adult↗
PubMed1996

Blood pressure measurement in the community: do guidelines help?

The measurement of blood pressure (BP) is a crucial part of clinical assessment and hypertension management, and is commonly performed inaccurately despite the publication of National and International consensus guidelines for its measurement. There have been no previous reports on the self-reported knowledge-base of General Practitioners (GPs) and Practice Nurses (PNs) with regard to BP measurement. A postal questionnaire survey was conducted of 831 community-based practitioners (550 GPs and 281 PNs) in north west London. The overall response rate was 61%. Previous education in BP measurement was recorded in 87% of the GPs and 95% of the nurses. Precision factors were recorded for the GPs and nurses respectively including rounding up or down (GP 67%, PNs 48%), routine use of diastolic phase V (GP 63%, PNs 70%), reading the BP to the nearest 2 mm mercury (GP 54%, PNs 70%) and failure to use a large BP cuff in the past 4 weeks (GP 33%, PNs 26%). Only 12% of the GPs and 19% of the nurses were able to name the source of the published guidelines. Overall the nurses had a statistically significantly greater knowledge base than the GPs, and both community groups had a greater knowledge for core questions than hospital practitioners from two previous surveys. Knowledge of a guideline source was associated with improved self-reported BP technique. There was a difference between reading and recording accuracy which deserves further study. These results show that there are important gaps in the knowledge of community practitioners with regard to the technique of BP measurement.

Blood Pressure Determination↗
PubMed1983

Management of intraepithelial conjunctival tumors and squamous cell carcinomas.

We compared the effects of excision, extensive freezing with a liquid nitrogen spray, and combined therapy with excision and superficial freezing with a liquid nitrogen probe on intraepithelial conjunctival tumors. After follow-up periods of at least 36 months, excision and extensive freezing produced recurrence rates similar to those previously reported (two of six lesions treated with excision alone recurred and three of nine treated with extensive freezing recurred), but excision combined with superficial freezing produced a recurrence rate of only 8% (two of 23 lesions recurred), almost three times better than any previously reported. Both lesions recurred in patients who had undergone previous therapy.

Adolescent↗
PubMed1980

Cryosurgery for malignancies of the eyelid.

The results of liquid nitrogen spray technique for 310 biopsy-proven eyelid malignancies are reviewed. The raw recurrence rate for basal cell carcinomas of the eyelids with a mean follow-up of almost three years is 4.2%, while the recurrence rate is 6% in 49 cases followed for five years. For all lid malignancies 10 mm or less in diameter, a 2.0% raw recurrence rate was obtained; however, in those lesions larger than 10 mm, this rose to 9.5%. With this form of therapy, basal cell carcinomas with infiltrative, nonelevated, indistinct borders had twice the recurrence rate than those tumors with elevated distinct borders. Twenty-one squamous cell carcinomas treated with cryosurgery with an average follow-up 21.6 months have yet to show a recurrence. Complications with cryosurgery include permanent loss of eyelashes and depigmentation lasting from six months to over six years. Depending on the extent and location of the tumor, eyelid defects occurred. To date, five plastic reconstructive procedures have been required for ectropion or lid defects; however, no lacrimal outflow surgery has as yet been required.

Adult↗
PubMedDate not supplied

Observational precision in general practice data: a technique for analysis and audit.

Terminal digit preference is a well-known source of error in blood pressure measurements. This was demonstrated in general practice computer databases by conducting a routine search and constructing a frequency distribution of the 20 992 blood pressure readings using mathematical software for a personal computer. The charts produced have a practical application in providing an audit tool whereby nurses and doctors can be made aware of this source of error, providing an opportunity for improving measurement technique and developing more refined and realistic protocols for blood pressure management in general practice. The same principles may be applied to other measurements made in the GP consultation such as peak expiratory flow rate.

Blood Pressure Determination↗