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J E Drake

Publications and source records attributed to J E Drake.

5 recordsLinked to original sources

Taking the lead in fundholding.

The prevalence of rather negative, or at best mixed, attitudes of doctors towards participation in management has been reported in several previous research studies. This paper adds to that growing empirical literature, but complements most of the previous studies by focusing on general medical practitioners in primary care rather than on doctors in secondary care settings. The focus for the study were doctors who had agreed to undertake the lead partner role in the now-defunct general practitioner fundholding initiative within the UK National Health Service. The findings indicate widespread reluctance but the presence of a minority of enthusiasts, which resonates with previous studies of secondary care settings. A finding of potential significance for future research and practice was that some doctors who were initially reluctant became more keen on undertaking a management role once they had experienced it.

Decision Making↗

Massive upper gastrointestinal hemorrhage in the elderly.

Sixty-six elderly patients with massive upper gastrointestinal bleeding were retrospectively analyzed. This study supports the concept of vigorous resuscitation, early diagnosis with fiberoptic endoscopy, and prompt surgical intervention in patients with continued bleeding. When this approach was utilized in a community hospital, operative mortality was reduced to 5 per cent.

Aged↗

Erythrocyte porphobilinogen synthase (delta-aminolaevulinate dehydratase) activity: a reliable and quantitative indicator of lead exposure in humans.

We assessed optimal conditions for assay of porphobillinogen synthase (EC 4.2.1.24) activity in human blood containing abnormally high concentrations of lead. Zn2+and -SH, both required for complete activation of the enzyme, had additive effects. Using a modified method based on these studies, we found blood lead concentration to be strictly proportional to ln(activated/nonactivated) enzyme activity. One brand of commercially available "lead-free" tubes contained a substance that interfered with this relationship. In vitro studies, with the modified assay, showed ALAD to be activated by low concentrations but inactivated by high concentrations of Hg2+, Cd2+, and ethylenediaminetetraacetate. We fouund no genetically influenced differences among unexposed individuals when in(activated/nonactivated) enzyme activities were compared. The technique is suitable for use in screening for lead poisoning in humans.

Cadmium↗