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Biomedical subjects

J B Macdonald

Publications and source records attributed to J B Macdonald.

18 recordsLinked to original sources
PubMed1992

How do local doctors react to a hospice?

Postal questionnaires were sent to general practitioner principals and hospital consultants in Ayrshire a year before and again 13 months after the opening of the Ayrshire Hospice. Seventy-three per cent of 342 doctors replied to the first survey and 62% replied to the second survey. There was initially a fairly strongly felt need for a hospice, with median Visual Analogue Score (VAS) of 16 ('definite need' = 0 and 'definitely no need' = 100). After the opening of the hospice doctors were much more enthusiastic (median VAS 5; p less than 0.0001). Doctors feeling no need for a hospice (VAS greater than 75) became fewer (9.6% before opening, 2% after). Doctors who would refer patients to a hospice, at first 82%, numbered 92% after opening. Seventy-one per cent of general practitioners and 60% of consultants had referred patients to the hospice within a year of opening. After opening, specialist advice with home care was considered the most useful aspect, in-patient beds useful, and day hospice least useful. Seventy-three per cent of referring doctors found the hospice a great help. In both surveys general practitioners and consultants felt the hospice should be run by a mixture of voluntary and NHS finance. Doctors appeared willing to learn about palliative care from hospice doctors, particularly after hospice opening. Doctors were initially rather dissatisfied with palliative care in existing hospitals, but became less so (particularly about pain control) after hospice opening. Surprisingly, in both surveys the attitudes of general practitioners and consultants were virtually identical.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗
PubMed1987

Prospective study of drug reporting by general practitioners for an elderly population referred to a geriatric service.

A prospective study was carried out in which the drug history of patients which was provided by general practitioners was compared with the drugs found by geriatricians in patients' homes in 700 referrals to geriatricians. Drug compliance was not assessed. The drug history appeared to be accurate in one third of referrals. Underreporting of medication was common and increased as the number of prescribed drugs increased. Roughly one fifth of patients had at least one potential drug interaction. Keeping careful prescription records, regular review, and accurate reporting of medication should reduce drug associated morbidity in elderly patients.

Aged↗
PubMed1985

The role of drugs in falls in the elderly.

Drugs can contribute to falls in the elderly. Older people have more diseases, take more medications, and more frequently have drug side effects. Current studies show that the link between drugs and falls is best illustrated by the barbiturates, and well founded with phenothiazines and tricyclic antidepressants. The more types of drugs a patient receives, the greater the likelihood of a fall. Combining drugs with various diseases adds to the risk. New research should concentrate on naming individual drugs in larger surveys of falling. Much more sophisticated statistical procedures and testing would allow analysis of the specific dangers of drug and drug/disease combinations.

Accidents↗
PubMed1977

Mycobacterium tuberculosis resistance to rifampicin and ethambutol: a clinical survey.

Ninety-seven cultures of Myco, tuberculosis referred to the Tuberculosis Reference Laboratory, Cardiff during 1972-73 and found to be resistant to rifampicin or ethambutol were studied. Resistance to each drug appeared equally common. Few lower grades of rifampicin resistance occurred, cultures tending to be either fully sensitive or highly resistant. Intermediate grades of ethambutol resistance, however, were common, and a majority of highly resistant cultures were preceded by cultures showing lower grades of resistance. Case-notes were obtained on 84 patients (87%) and revealed no cases of primary resistance. In the three years since first developing resistance 36% of patients died: in the majority tuberculosis was a major cause of death. Half the patients had been prescribed unsatisfactory drug regimens containing rifampicin or ethambutol by their physicians, and only a small minority were considered to have co-operated well. One-third had discharged themselves from hospital against medical advice and only 21% attended clinics regularly. These two factors probably accounted for the development of resistance in most cases.

Drug Resistance, Microbial↗
PubMed1976

Asthma deaths in Cardiff 1963-74: 90 deaths outside hospital.

In a detailed study of factors associated with death from bronchial asthma outside hospital 90 patients were investigated. The fatal attack was typically short and was most likely to occur in patients with a long history. Deaths often occurred before effective medical help was obtainable, but occasionally the patient or the doctor underestimated the severity of the attack. Patients especially at risk were those recently discharged from hospital after a previous attack. These deaths might be prevented by better patient education, a self-admission service for selected asthmatics, and by doctors using objective measurements of severity of asthma for the control of treatment. The underuse of corticosteroids is an important factor associated with death.

Adolescent↗
PubMed1975

Fibreoptic bronchoscopy today: a review of 255 cases.

An analysis of 255 fibreoptic bronchoscopies showed that the major indication for bronchoscopy was suspected bronchial carcinoma (93% of cases). Of the 183 patients finally shown to have bronchial carcinoma 83% had abnormal bronchoscopy findings and 65% had bronchial biopsy specimens diagnostic of malignancy. These figures were superior to those obtainable with rigid bronchoscopy, particularly with upper lobe and peripheral tumours. Brush biopsy and bronchography were useful supplementary techniques. Sputum cytology gave poorer results than fibreoptic bronchoscopy, but enabled diagnosis in some otherwise undiagnosed cases. The complication rate was low and the claim of this new technique to be the investigation of choice in bronchial carcinoma seemed to be justified in clinical practice.

Biopsy↗
PubMed1975

Forced expiratory time--its reliability as a lung function test.

Three studies of factors affecting variability of forced expiratory time (FET) have been carried out. In the first, different observers or repeated measurements over a few minutes were shown to make no significant contribution to FET variability. Time of day was also relatively unimportant. In the second study, FET was shown to vary considerably more than peak flow rate, forced expiratory volumes, and mid expiratory flow rates over the course of five days. In the third study, FET was shown to correlate with other measurements of airways obstruction though the correlation coefficients were relatively low. The measurement of FET is thought to be too variable to be of practical use as a screening test for small airways disease, though its clinical value is not questioned.

Adolescent↗