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Biomedical subjects

F Walters

Publications and source records attributed to F Walters.

10 recordsLinked to original sources
PubMed1996

Pain after craniotomy. A time for reappraisal?

Pain and nausea were prospectively assessed in 52 patients following elective craniotomy. When assessed at 6-hourly intervals the mean pain scores in patients during the first 24 h for all types of craniotomy were relatively low. However, for a period of at least 2 h 18% of patients complained of excruciating pain, 37% of patients complained of severe pain, 29% of patients complained of moderate pain, 4% of patients complained of mild pain and only 12% of patients complained of no pain in the 24 h following craniotomy. The mean dose of codeine phosphate used within the study period was 123 mg (SD 81). No statistically significant differences in severity of pain or use of codeine phosphate were found when comparing patients undergoing craniotomy at different sites. For at least 2 h 37% of patients complained of severe nausea or vomiting, 35% of patients complained of moderate nausea and only 29% of patients reported no symptoms of nausea during the 24-h study period. Again, no statistically significant differences were found in the severity of emetic symptoms when comparing patients undergoing craniotomy at different sites. Contrary to standard assumptions, severe or moderate pain in the first 24 h after craniotomy is common and is poorly treated with codeine phosphate alone.

Adolescent↗
PubMed1994

The value of the vaginal pack test in large cystoceles.

To detect possible stress urinary incontinence associated with but masked by large cystoceles protruding through the vaginal orifice, a vaginal pack test was done in conjunction with video fluoro-urodynamic studies. Sixteen female patients with large cystoceles did not demonstrate stress urinary incontinence on clinical examination and were included in this study. Additionally, 10 healthy female volunteers underwent the same test to study the effect of a vaginal pack on urethral dynamics. The vaginal pack revealed the presence of stress urinary incontinence in 11 patients (69%): 3 (19%) with type II (vesicourethral hypermobility) and 8 (50%) with type III (internal sphincteric deficiency). After insertion of the vaginal pack, urodynamic studies showed that the closing proximal urethral pressure in patients with stress urinary incontinence was significantly lower than in continent patients (p < 0.05). No significant change in urethral pressures was noted in volunteer subjects after vaginal pack insertion. Fluoroscopy showed kinking of the posterior urethra and enlargement of the most dependent portion of the cystocele, that is the lower half of the hourglass image. Our study suggests that the mechanisms of continence in these patients are multifactorial, including urethral kinking, urethral compression and pressure dissipation. The vaginal pack test is easy to perform, increases visualization of the vesicourethral unit when used with fluoroscopy, and can aid in the selection of patients who would benefit from anti-incontinence surgery and/or cystocele repair.

Adult↗
PubMed1993

Cell wall deficient bacteria as a cause of idiopathic hematuria.

Idiopathic hematuria in the absence of bacteriuria is a medical challenge. Routine cultures of catheterized bladder and endoscopically obtained ureteral urine specimens from a 22-year-old woman with a 6-week history of hematuria showed no growth after 24 to 48 hours of incubation. However, bacterial variants were grown on enriched media. Colonies were typical cell wall deficient/defective bacteria. Phase and electron microscopy of cystoscopic urine specimens obtained by retrograde ureteral catheterization as well as phase microscopy of the cultures revealed the classic morphology of these organisms. When the variant cultures were subcultured the organisms reverted to their related walled forms, that is Streptococcus agalactiae and Staphylococcus haemolyticus. Because the colonies of these organisms showed various patterns of biochemical reactivity, each phenotype was tested against 15 antimicrobials. Collectively, all biotypes had a common susceptibility to only nitrofurantoin. The patient was treated with nitrofurantoin for 6 weeks. Four days after initiation of therapy she had complete remission of hematuria. During the next 3 years she remained well and free of hematuria.

Adult↗
PubMed1988

Preference segmentation of health care services: the old-fashioneds, value conscious, affluents and professional want-it-alls.

The results of a national segmentation study are reported. The findings extend the empirical work of Finn and Lamb and the benefit-seeking conjectures by Kotler and Clarke that consumers with preferences toward specific hospitals can be segmented into a few distinct groups. The groups described in the findings are identified as the value conscious, the affluents, the old-fashioneds, and the professional want-it-alls. Each segment has a unique demographic profile. The substantial importance of doctors' recommendations in influencing hospital choice is supported for all four consumer segments. Suggestions for additional research and hospital marketing strategies are provided.

Choice Behavior↗
PubMed1986

The future of general practice in Newcastle upon Tyne.

A plan is presented for the future of general practice in Newcastle upon Tyne, in which general practices rather than individual practitioners would be responsible for providing a package of guaranteed minimum services. The services would include, at least, 24 h care of acute illness, continuity of care, management of specified chronic conditions according to agreed protocols, and certain preventive programmes. A computerised reporting system linked to computerised patient registration would enable targets to be set for the preventive programmes. Such an approach to primary health care follows the philosophy of Health for All, and could form the basis of a new general practitioner contract. Appropriate government funding in the future might be assured if general practice could demonstrate its ability to deliver a cost-effective service.

Community Health Services↗