Biomedical subjects
Publications and source records attributed to J Fry.
The use of vacuum casting to create better-fitting orthoses for special athletic shoes has been discussed. By vacuum-forming a negative cast within the confines of special athletic shoes, such as bicycling cleats or fencing shoes, a better-fitting orthosis can be fabricated with little or no special adjustments or modifications necessary to create the best fit and function.
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Patterns of consultation for physical illness were analysed in a body of consultation data covering a continuous 20 year period from a single general practitioner in south London. Three groups of adult patients were identified: patients with a psychiatric disorder and a new prescription for a psychotropic drug; patients with a psychiatric disorder but no new prescription for a psychotropic drug; and a control group without psychiatric disorder. The percentages of patients having one or more consultation for physical illnesses were stable over the years studied, being roughly 90%, 85%, and 60% respectively. For groups identified in 1972 their patterns of consultation for physical illness were examined in 1957, 1962, and annually from 1967 to 1976. In every year studied except 1957 the group with a psychiatric disorder and a new prescription for a psychotropic drug exceeded both other groups in the percentage of patients having one or more consultations for physical illnesses. Both groups with psychiatric disorders had an excess of consultations over the control group; this excess halved in about four years for the group with a new prescription and in about one year for the group without a new prescription. Mental health care by general practitioners for patients with psychiatric disorders does not seem to have an offset effect on general health care of these patients.
The domiciliary consultation scheme introduced at the start of the NHS enables joint consultation between a consultant and general practitioner in a patient's home when the patient cannot attend hospital on medical grounds. Consultants claim a fee from the NHS, general practitioners do not. Data from the Department of Health and Social Security on domiciliary consultations in England and Wales during 1981-6 were analysed. The number of domiciliary consultations fell during 1981-6 from 429,759 in 1981 to 387,394 in 1986, a fall of 10%, whereas the numbers of consultants and general practitioners increased by 1404 (12%) and 2400 (10%), respectively. The yearly rate of domiciliary consultation per consultant fell by 19% from 36 in 1981 to 29 in 1986 and that per general practitioner by 18% from 18 to 15. In 1986 geriatric medicine had the highest rate of domiciliary consultation per consultant (187) followed by psychiatry (89), general medicine (52), dermatology (49), rheumatology (42), general surgery (36), gastroenterology (35), thoracic medicine (34), and orthopaedics (30). In 1986 all specialties apart from clinical pharmacology and therapeutics and clinical genetics showed a decrease in the yearly rate of domiciliary consultation when compared with the rate for 1981. Domiciliary consultation seems to have become a domiciliary visit by the consultant alone. At an estimated cost of about 20m pounds for 1988 the scheme needs critical evaluation.
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Myxamoebae of Physarum polycephalum, strain Cld, were grown on agar lawns on live bacteria. Myxamoebae were harvested, fixed and stained with propidium iodide. Flow cytometry showed that, as in the case of Physarum plasmodia, there is no G1 phase during rapid exponential growth. However, an apparent G1 phase was observed at the end of exponential growth when the culture arrested with the G1 DNA content for about a day between growth and differentiation. Most myxamoebae differentiated into cysts, but some formed microplasmodia and others appeared to lose DNA. The cysts possessed the G2 phase DNA content and there was an S phase connecting the G1-arrested state with the encysted state. Encystment was blocked by hydroxyurea (HU) suggesting that DNA synthesis is essential for encystment. The natural temporary synchronization in G1 phase may provide the basis of a method for selecting mutants with a conditional block in G2 or M phases.
General practice is one of the three bases of care in the British National Health Service (NHS); the other two are hospital and community services. Each is administered separately. There are 30,000 general practitioners (for a population of 57 million), who are independent and can organize their work as they see fit. Few are single-handed (13 percent) and the majority work in groups of three to five physicians. They are paid by capitation fees, and fees for specific services, and also receive reimbursements for staff, premises rental, and local taxes (rates). They work in close association with practice teams that include nurses, midwives, and social workers. There are no universal hospital privileges but many general practitioners hold appointments in local hospitals. Important trends in the NHS include mandatory vocational training of general practitioners for three years; the growing importance of attempts by the Royal College of General Practitioners to shift care from the hospital to the community; increased patient participation; clashes between the government and the medical profession over restricted funding of the NHS; definition and improvement of "quality," and a need for improved data collection; and long waits for hospital services.
Annual patient consultation rates have been recorded continuously for 36 years in a stable National Health Service practice in a south-east London suburb. Four phases in consultation rates were noted: rising rates from 1950 to 1956; peak rates from 1957 to 1963; falling rates from 1964 to 1970 and low stable rates from 1971 to 1985. Thus workload fell by almost 50%, from a peak of 3.81 to a low of 1.93 consultations per patient per year. The reduction of 91% in home visits was much greater than the 43% reduction in surgery (office) consultations.CERTAIN QUESTIONS ARE RAISED BY THE STUDY: why are the consultation rates of this practice so low (one half the national rates); why have consultation rates in the practice fallen; and how many general practitioners are needed by the NHS? More studies are needed which compare practices, their processes and outcomes, and which analyse cost benefits in the health service.
In an earlier study it was shown that general practitioners changed some of their prescribing habits when they were given detailed analyses of their prescriptions every six months for two years and provided with opportunities to discuss the information with participating colleagues. A follow-up study of the same doctors two years later revealed that most of the effects of the intervention had disappeared, though the increase in generic prescribing persisted. It is concluded that a more sustained intervention is needed to bring about more lasting change.
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Four natural occurrences of zinc toxicity in sheep and one in calves were studied. To assist in the confirmation of a diagnosis of zinc toxicity, 2 experiments were conducted in which sheep were given toxic amounts of zinc. The clinical findings, clinical pathology, and gross and microscopic pathology are given. Clinical manifestations included inappetance, loss of condition, diarrhoea with dehydration or subcutaneous oedema, profound weakness and jaundice. Significant rises in the concentration of zinc were usually found in the liver, kidney and pancreas, but occasionally in only 1 or 2 of these organs. Many affected sheep were anaemic. Pathological changes were found in the pancreas, kidney, liver, rumen, abomasum, small intestine and adrenal gland. Lesions in the kidney and abomasum apparently made the most significant contribution to the deterioration in health of affected animals, but the pancreas was the only organ consistently affected. The degenerative changes in the pancreas were mainly restricted to the exocrine portion of the organ, and regeneration of the damaged tissue was observed although exposure to toxic amounts of zinc continued. Attention is drawn to the importance of the pancreas in the diagnosis of zinc toxicity and in estimating the period of exposure.
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