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J Payne-James

Publications and source records attributed to J Payne-James.

At least 19 recordsLinked to original sources
PubMed1995

Violence in clinical forensic medicine.

OBJECTIVE: to investigate the levels of physical and verbal violence experienced in the preceding year by doctors working in clinical forensic medicine. DESIGN AND SUBJECTS: anonymised questionnaire sent to all full members of the Association of Police Surgeons. RESULTS: 517 eligible questionnaires were returned; 18.2 per cent of respondents had experienced physical violence, a total of 150 incidents. Of those incidents 'warning signs' of violence had been present in only 25 per cent. A total of 54 working days were lost. Injuries included a fractured wrist and corneal scarring. Of the respondents, 65.5 per cent had experienced verbal violence (of which the most common type was obscenity); 11.8 per cent had received training in dealing with verbal violence and 10.4 per cent in dealing with physical violence; 88 per cent believed that training on how to deal with violence should be part of police surgeon/forensic medicine training. CONCLUSION: verbal and physical violence are common in clinical forensic medicine. Training in dealing with these issues should be introduced.

Education, Medical, Continuing↗
PubMed1989

Inflammatory bowel disease: nutritional implications and treatment.

It is clear that the nutritional state of patients with inflammatory bowel disease is often impaired and that the provision of nutritional support results in an improvement in nutritional state of these patients. Improvement in nutritional status can be achieved as effectively with enteral as with parenteral nutrition. The nutritional support appears to have no primary therapeutic effect in patients with ulcerative colitis. With regard to nutritional support in Crohn's disease, parenteral nutrition should be restricted to use as supportive rather than primary therapy. Available information now seems to suggest that most of the benefits of parenteral nutrition in Crohn's disease are related to improvement in nutritional state rather than as primary therapy, and its use should be restricted to treatments of specific complications of Crohn's disease, such as intestinal obstruction, related to stricture formation or short bowel syndrome following repeated resection. The present available evidence indicates that defined elemental diets may have a primary therapeutic role in the management of first acute attacks of Crohn's disease when there is a need to improve the nutritional status of patients with inflammatory bowel disease as an adjunct to primary drug therapy. Enteral nutrition is as efficacious as parenteral nutrition; moreover, it is safer to administer and more cost-effective.

Colitis, Ulcerative↗
PubMed1988

A trial of mezlocillin versus cefuroxime with or without metronidazole for the prevention of wound sepsis after biliary and gastrointestinal surgery.

A randomized controlled trial was undertaken to compare the role of mezlocillin, as the sole prophylactic agent, with a combination of cefuroxime and metronidazole in patients undergoing biliary and gastrointestinal surgery. No difference in wound infection rates was seen in patients following appendicectomy, biliary or gastro-oesophageal surgery. A significantly higher wound infection rate was seen in patients undergoing colorectal surgery who received mezlocillin alone (30.2%) compared with those receiving cefuroxime and metronidazole (11.5%): this rate was similar to that of historical placebo controls in other units. The wound infections seen in patients receiving mezlocillin alone were polymicrobial involving organisms of faecal origin, including non-sporing anaerobes which were predominantly sensitive to mezlocillin. Infections due to Staphylococcus aureus, resistant to mezlocillin, were more frequent in patients receiving mezlocillin and usually secondary in nature. We conclude that mezlocillin may be an effective sole prophylactic agent in appendicectomy but not in colorectal surgery; the possible reasons for failure to adequately prevent infection, following colorectal surgery, are discussed.

Biliary Tract Diseases↗
PubMed1988

Enteral nutrition: background, indications and management.

Enteral nutrition is only part of the wider field of clinical nutrition in which great advances in both theory and practice have been made over the last decade. We have attempted to summarize what we consider to be the advances that have most relevance to the clinical practice of enteral nutrition. This chapter reviews our present understanding of the processes of digestion and absorption of protein, carbohydrate and fats, and examines how this theoretical understanding can be applied to patients in the clinical situation. A broad classification of the different enteral diets is undertaken, and the reasons for the development of particular diets are discussed. The clinical value of these diets is assessed. The wide variety of indications for enteral (as opposed to parenteral) nutrition are discussed and the specific benefits of enteral nutrition for the patient are highlighted. Techniques of administration of enteral nutrition are reviewed in detail, and the methods by which enteral nutrition should be monitored are outlined. Finally, complications of enteral nutrition are summarized and advice given on how to prevent or treat them.

Dietary Carbohydrates↗