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Biomedical subjects

J Pell

Publications and source records attributed to J Pell.

At least 19 recordsLinked to original sources
PubMed2001

Case-mix adjusted incidence of pressure ulcers in acute medical and surgical wards.

Pressure ulcers cause considerable pain and suffering and are also a very expensive drain on NHS funding. Measuring prevalence is particularly useful for guiding use of resources whereas incidence is an outcome indicator of quality of care. Patients and illnesses vary and it may be misleading to make assumptions based on crude incidence figures. A system of case-mix adjustment has been developed in Glasgow (GPSISS). This study used GPSISS to measure case-mix adjusted incidence of pressure ulcers in over 15,000 acute hospital patients. The incidence of pressure ulcers ranged from 1.1% to 2.7%. These low rates, and the time cost and effort involved in ensuring quality data, suggests that significant differences in quality of care may be demonstrated more quickly using processes rather than outcomes and may more directly identify where changes in practice are required.

Adult↗
PubMed1999

Association between age and survival following major amputation. The Scottish Vascular Audit Group.

OBJECTIVES: To determine whether age is associated with survival following major amputation and whether this association is independent or simply reflects selection bias in amputation level. DESIGN AND MATERIALS: Computer linkage of routine discharge and death data on the 2759 patients undergoing major amputation in Scotland between 1989 and 1993 for peripheral arterial disease. METHODS: Cox's proportional hazards model and multivariate logistic regression analysis using death as the outcome variable and age, sex, urgency, amputation level and recent arterial reconstructive surgery as predictor variables. RESULTS: Proximal amputation was more common in older patients. Survival was associated with both age (p < 0.001) and amputation level (p < 0.001). Age was an independent predictor of death at 30 days (p < 0.0001), 6 months (p < 0.001), 12 months (p < 0.0001) and 2 years (p < 0.0001) postoperation. CONCLUSIONS: Survival following amputation was poor, with only half the patients alive at 2 years. Above-knee amputation was associated with poorer survival, presumably due to the presence of more severe and widespread disease, and was undertaken more commonly in older patients. However, age remained a predictor of survival after adjustment for amputation level. Higher early mortality suggest that a worse prognosis in elderly patients cannot be attributed wholly to actuarial considerations.

Adult↗
PubMed1999

Do nursing home residents make greater demands on GPs? A prospective comparative study.

BACKGROUND: The number of people residing in nursing homes has increased. General practitioners (GPs) receive an increased capitation fee for elderly patients in recognition of their higher consultation rate. However, there is no distinction between elderly patients residing in nursing homes and those in the community. AIM: To determine whether nursing home residents receive greater general practice input than people residing in the community. METHOD: Prospective comparative study of all 345 residents of eight nursing homes in Glasgow and a 2:1 age, sex, and GP matched comparison group residing in the community. A comparison of contacts with primary care over three months in terms of frequency, nature, length, and outcome was carried out. RESULTS: Nursing home residents received more total contacts with primary care staff (P < 0.0001) and more face-to-face consultations with GPs (P < 0.0001). They were more likely to be seen as an emergency (P < 0.01) but were no more likely to be referred to hospital, and were less likely to be followed-up by their GP (P < 0.0001). Although individual consultations with nursing home residents were shorter than those with the community group (P < 0.0001), the overall time spent consulting with them was longer (P < 0.001). This equated to an additional 28 minutes of time per patient per annum. Some of this time would have been offset by less time spent travelling, since 61% of nursing home consultations were done during the same visit as other consultations, compared with only 3% of community consultations (P < 0.0001). CONCLUSION: Our study suggests that nursing home residents do require a greater input from general practice than people of the same age and sex who are residing in the community. While consideration may be given to greater financial reimbursement of GPs who provide medical care to nursing home residents, consideration should also be given to restructuring the medical cover for nursing home residents. This would result in a greater scope for proactive and preventive interventions and for consulting with several patients during one visit.

Aged↗
PubMed1998

Stimulatory effect of insulin on calcitonin secretion.

Infusion of insulin directly into thyroid arterial blood perfusing the surgically isolated in situ pig thyroid gland produced an increase in the secretion rate of calcitonin (CT) measured by immunoassay in thyroid venous effluent blood. Insulin in concentrations ranging from approximately 1 to 400 ng/ml produced a maximal stimulation of 4-5 fold. The stimulatory effect of insulin on CT could not be duplicated by infusion of either IGF-I or amylin. Specific binding of radiolabeled insulin was demonstrated using isolated pig thyroid plasma membranes and both rat (6-23) and human (TT) medullary thyroid carcinoma C-cells. Increased CT release was observed from C-cells exposed to a high concentration of insulin. The administration of glucose iv to pigs in order to stimulate secretion of endogenous insulin produced an increase in circulating insulin, which was accompanied by an increase in the secretion of CT. The results show that insulin, delivered directly to the pig thyroid gland, can stimulate CT release. The in vitro binding and secretion studies indicate that C-cells can bind insulin and respond with an increase in CT secretion, and the iv glucose experiments suggest that endogenous insulin is capable of stimulating CT secretion. The findings imply that insulin is capable of acting as a CT secretagogue and suggest that changes in CT secretion may accompany altered states of insulin production such as diabetes or insulin-secreting tumors.

Animals↗
PubMed1997

Acute upper gastrointestinal haemorrhage in west of Scotland: case ascertainment study.

OBJECTIVES: To determine the incidence and case fatality of acute upper gastrointestinal haemorrhage in the west of Scotland and to identify associated factors. DESIGN: Case ascertainment study. SETTING: All hospitals treating adults with acute upper gastrointestinal haemorrhage in the west of Scotland. SUBJECTS: 1882 patients aged 15 years and over treated in hospitals for acute upper gastrointestinal haemorrhage during a six month period. MAIN OUTCOME MEASURES: Incidence of acute upper gastrointestinal haemorrhage per 100,000 population per year, and case fatality. RESULTS: The annual incidence was 172 per 100,000 people aged 15 and over. The annual population mortality was 14.0 per 100,000. Both were higher among elderly people, men, and patients resident in areas of greater social deprivation. Overall case fatality was 8.2%. This was higher among those who bled as inpatients after admission for other reasons (42%) and those admitted as tertiary referrals (16%). Factors associated with increased case fatality were age, uraemia, pre-existing malignancy, hepatic failure, hypotension, cardiac failure, and frank haematemesis or a history of syncope at presentation. Social deprivation, sex, and anaemia were not associated with increased case fatality after adjustment for other factors. CONCLUSIONS: The incidence of acute upper gastrointestinal haemorrhage was 67% greater than the highest previously reported incidence in the United Kingdom, which may be partially attributable to the greater social deprivation in the west of Scotland and may be related to the increased prevalence of Helicobacter pylori. Fatality after acute upper gastrointestinal haemorrhage was associated with age, comorbidity, hypotension, and raised blood urea concentrations on admission. Although deprivation was associated with increased incidence, it was not related to the risk of fatality.

Adolescent↗
PubMed1997

Factors affecting the use of folic acid supplements in pregnant women in Glasgow.

BACKGROUND: Use of folic acid supplements preconception, and during the first trimester, is associated with a reduced incidence of first and subsequent neural tube defects. The Department of Health guidelines recommend the use of folic acid supplements by all women planning a pregnancy. AIM: To ascertain the proportion using folic acid supplements and the factors affecting their use. METHOD: Questionnaires were distributed postpartum to the 515 women who delivered normal babies in three maternity units in Glasgow over a four-week period. RESULTS: Forms were completed by 487 (95%) women. Only 57% took supplements at some point during their pregnancy, and only 21% took them before conception. Failure to take supplements was significantly associated with unplanned pregnancy, younger age, and previous pregnancies. Lack of awareness of the potential benefits associated with folic acid use was the commonest reason cited by women for not taking supplements. CONCLUSIONS: Increased health education through health care professionals and mass media campaigns can improve awareness and thereby increase the use of supplements in planned pregnancies. However, 42% of women in our study had unplanned pregnancies. Intake of folic acid supplements in this group can only be increased by improvements in dietary intake within the population as a whole, and by fortification of commonly ingested foods.

Female↗
PubMed1996

Management of HIV infected health care workers: lessons from three cases.

Three cases in which doctors in Glasgow were diagnosed as having HIV infection were all handled differently in relation to telling patients and the media. In the first patients were not told because the doctor had been doing administrative work and there was thought to be no risk to patients; although the media did report the case, it accepted the assurances given. In the second case, where a doctor had done many jobs in different specialties and places, the media identified the doctor before most patients had been informed: most calls to the helpline subsequently set up by the health authority were from patients who had not been treated by this doctor. This episode, however, allowed the incident team to be prepared for the next case, enabling the helpline to be established swiftly. In this case the doctor voluntarily identified himself, and this served to allay public fears and reduce the number of inappropriate calls to the helpline.

Confidentiality↗
PubMed1996

An audit of BCG immunisation and tuberculin skin testing in Scotland. Scottish BCG Study Group.

BACKGROUND: BCG vaccination of all tuberculin-negative schoolchildren has been undertaken in the United Kingdom since 1954. In light of the ten-fold decline in tuberculosis, mass vaccination may no longer be justified. Since most tuberculosis cases now occur among identifiable high-risk groups, restriction of vaccination to these groups may be more appropriate. Before such changes can be recommended, further information is required on current practice within Scotland. OBJECTIVE: To determine current BCG vaccination practice within Scotland, in order to inform planning of future immunisation services. DESIGN: Postal questionnaire survey. SETTING AND SUBJECTS: The questionnaires were posted to the Consultant in Public Health Medicine responsible for Communicable Disease Control in each of the fifteen Scottish Health Boards. RESULTS: Completed questionnaires were returned by all 15 Health Boards. Marked variations were reported in the vaccination of both schoolchildren and high-risk groups. Six (40%) Health Boards immunised all tuberculin-negative children, whereas the remainder excluded those with evidence of previous BCG vaccination. All Health Boards immunised contacts of tuberculosis cases, 11 offered it to healthcare workers and 11 to immigrants from countries with a high prevalence of tuberculosis. However, only 7 offered it to the offspring of high-risk ethnic groups, 5 to students and 4 to animal workers. CONCLUSION: There are marked variations in current BCG vaccination practice. Greater efforts are required to ensure that high-risk groups receive vaccination.

Adolescent↗