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Biomedical subjects

D Worthington

Publications and source records attributed to D Worthington.

At least 19 recordsLinked to original sources
PubMed1999

Spontaneous resolution of an in utero perirenal urinoma associated with posterior urethral valves.

Ultrasound imaging of a 26-week-gestation fetus demonstrated a large, nonemptying bladder. At 27 weeks, a distended, thick-walled bladder, left hydronephrosis, and a perirenal urinoma were present, without ascites. Observation was undertaken, as the amniotic fluid volume was normal. At 29 weeks, the left perirenal fluid collection persisted but, at 30 weeks, was absent. After delivery at 36 weeks, no ultrasound evidence for perirenal urinoma or ascites was present. Isotope renal scan showed preserved renal function bilaterally. This case illustrates that in utero urinomas associated with posterior urethral valves can resolve spontaneously, with preservation of renal function.

Adult↗
PubMed1998

Specialty location decisions in the reformed NHS: a case study.

A soft systems approach, largely based on soft systems methodology, was used to steer a study (completed in 1996) of the National Health Service contracting process. It led to action research projects on a number of related issues. One such area that emerged very strongly concerns service rationalization and service planning, and in particular the location of 'small' specialties. A Trust-based study involving patient flow modelling demonstrates the form these problems can take within the internal market and highlights the challenge they make to the contracting process or the new primary care group based commissioning process if they are to be resolved in a rational manner.

Catchment Area, Health↗
PubMed1995

The prognostic significance of caffeine half-life in saliva in children with chronic liver disease.

To evaluate its clinical value, the half-life of caffeine (1,3,7-trimethylxanthine) in saliva (SCT) after 3 mg/kg-1 oral caffeine was measured in 53 children with chronic liver disease (mean age, 4.41 years) and 48 control children (mean age, 6.26 years) in five samples over 24 h and compared with parameters of liver function and outcome. Sensitivity was 60.3% and specificity 97% of SCT for diagnosis of chronic liver disease. The correlation of SCT with serum albumin (ALB) was -0.52 (p < 0.001), total bilirubin (SBR) was 0.585 (p < 0.001), prolonged prothrombin time (PT) was 0.387 (p = 0.004), and aspartate aminotransferase (AST) was 0.538 (p = 0.001). The correlation of SCT with a clinical score of liver dysfunction calculated from the presence of features of hepatic decompensation was 0.627 (p < 0.001) and with Malatack's paediatric prognostic score was 0.505 (p < 0.001). Serial SCT and liver function tests were performed on 53 patients on 127 occasions during a mean follow-up of 361 days (range, 4-709). Of this group, 18 were listed for liver transplantation. Predictive values of outcome by analysis of variance expressed as ratio of mean squares were SBR, 34.1 (p < 0.001); log10 SCT, 20.6 (p < 0.001); ALB, 5.2 (p < 0.05); PT, 1.2 (NS). SCT correlated with clinical and biochemical parameters of severity of liver disease, but SBR was a better predictor of listing for liver transplantation in this group of paediatric patients.

Adolescent↗
PubMed1995

Nebulised amiloride in respiratory exacerbations of cystic fibrosis: a randomised controlled trial.

OBJECTIVE: To assess the benefit of nebulised amiloride added to the standard inpatient treatment of a respiratory exacerbation in cystic fibrosis. DESIGN: Prospective, randomised, double blind, placebo controlled trial. SUBJECTS: 27 cystic fibrosis patients (mean age 12.8 years). SETTING: Two hospitals in Leeds, UK. RESULTS: Both forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) showed improvements over the course of treatment, although there was no difference in respiratory function between the two groups at any of three time periods during the study. The time to reach peak FVC was significantly reduced in the amiloride group (4.2 v 7.6 days; 95% CI 0.4 to 6.4 days), but not in the time to reach peak FEV1 (5.7 v 7.9 days; 95% CI -1.2 to 5.6 days). CONCLUSIONS: Amiloride did not result in a greater overall improvement in respiratory function. There was a suggestion that it may have an effect on the rate of improvement, and thus may possibly influence the duration of treatment. This hypothesis deserves further evaluation.

Adolescent↗
PubMed1993

Improving out-patient appointment systems.

The Patient's Charter has recently set the standard for hospital out-patient clinics that patients will "be given a specific appointment time and will be seen within 30 minutes of that time". Describes the successful application of an operational research/operations management approach to out-patient appointment systems at the Royal Lancaster Infirmary. Draws the conclusion from a comparison of this and other studies that many hospitals face very similar problems with similar solutions; but that localized studies may often be required to achieve these solutions.

Appointments and Schedules↗
PubMed1990

Recruitment, retention and return--some quantitative issues.

Recruitment, retention and return are the main sources of nurses for the NHS, which it has been argued need to be increased to combat the anticipated nurse supply problem. This paper discusses some of the quantitative issues associated with the problem and its possible solutions. Example analyses of available data suggest that the key question should be one of choosing a good solution rather than simply accepting any solution. Coordinated analyses of further data as it becomes available are also recommended.

Adolescent↗
PubMed1983

Factors influencing survival and morbidity with very low birth weight delivery.

Factors influencing survival and morbidity in a group of 214 consecutively delivered very low birth weight infants (500 to 1500 g) are examined. The perinatal mortality was 313 per 1000 births. Of 185 live-born, congenitally normal infants, 133 (72%) were discharged alive. Respiratory distress syndrome was the most common form of significant morbidity, occurring in 114 infants (62%). Intraventricular hemorrhage was diagnosed in 38 (21%) of the infants. Neither survival nor morbidity was influenced by the mode of delivery. The current trend of a liberalized policy of cesarean section for the very low birth weight delivery is questioned.

Apgar Score↗
PubMed1981

Effects of reduction of placental size in sheep.

The number of uterine caruncles was reduced by electrocautery in nonpregnancy sheep. Subsequent pregnancies were studied as chronic fetal sheep preparations between 110 days' gestation and term; findings were compared with those for control chronic fetal sheep preparations at a similar gestational age. As a result of decreased weight and reduced number of cotyledons, the placenta in experimental animals was significantly smaller compared with that in controls. The weights of the fetal liver and heart were decreased, fetal PO2 was decreased, and fetal PCO2 and hematocrit levels were increased in the experimental group. Fetal plasma fructose levels were decreased in experimental animals, but fetal blood lactate, pyruvate, and plasma glucose levels were similar in both groups. No differences were demonstrated in fetal plasma or amniotic fluid cortisol levels and amniotic fluid lecithin : sphingomyelin ratios. Fetal respiratory-like activity was significantly depressed in the experimental group.

Animals↗
PubMed1978

Modification of ovine fetal respiratory-like activity by chronic diazepam administration.

Chronic maternal administration of diazepam resulted in a modification of fetal respiratory-like activity (FRLA) in the sheep. An over-all increase in this activity occurred. This increase was probably due to a rebound effect following periods of acute suppression with each administration of diazepam. Loss of central control in the regulation of FRLA was implied. A complete reversal of a circadian rhythm of FRLA was observed in animals receiving diazepam. These changes have implications with respect to the antenatal monitoring of the fetus and sequelae in the newborn infant.

Animals↗