Biomedical subjects
J Preece
Publications and source records attributed to J Preece.
A sharp debridement procedure devised by specialist nurses.
In the clinical governance era, self-education is not adequate training for nurses to carry out sharp debridement, which is a risky process. Specialist nurses in south-east London drew up a workable procedure for training and practice.
Effects of a clinical-practice guideline and practice-based education on detection and outcome of depression in primary care: Hampshire Depression Project randomised controlled trial.
BACKGROUND: Depression is a major individual and public-health burden throughout the world and is managed mainly in primary care. The most effective strategy to reduce this burden has been believed to be education of primary-care practitioners. We tested this assumption by assessing the effectiveness of an educational programme based on a clinical-practice guideline in improving the recognition and outcome of primary-care depression. METHODS: We carried out a randomised controlled trial in a representative sample of 60 primary-care practices (26% of the total) in an English health district. Education was delivered to practice teams and quality tested by feedback from participants and expert raters. The primary endpoints were recognition of depression, defined by the hospital anxiety and depression (HAD) scale, and clinical improvement. Analysis was by intention to treat. FINDINGS: The education was well received by participants, 80% of whom thought it would change their management of patients with depression. 21409 patients were screened, of whom 4192 were classified as depressed by the HAD scale. The sensitivity of physicians to depressive symptoms was 39% in the intervention group and 36% in the control group after education (odds ratio 1.2 [95% CI 0.88-1.61]). The outcome of depressed patients as a whole at 6 weeks or 6 months after the assessment did not significantly improve. INTERPRETATION: Although well received, this in-practice programme, which was designed to convey the current consensus on best practice for the care of depression, did not deliver improvements in recognition of or recovery from depression.
Iowa cochlear implant clinical project: results with two single-channel cochlear implants and one multi-channel cochlear implant.
Cochlear implants have become a realistic alternative for the management of profoundly deaf patients. A variety of implants with differing electrode designs and coding strategies have been developed by nine major implant centers around the world. Each center has their "star" patient, but objective comparisons between these different implant designs are unavailable. In order to determine the performance characteristics of the present generation of cochlear implants, comparison data are vital. We have developed an independent center where uniform objective comparisons of different cochlear implants can be performed longitudinally. This report will present results of nine patients implanted with three different cochlear implant prostheses. Four patients have been implanted with the Los Angeles (House) single-channel implant, three patients have received the Vienna (Hochmair) single-channel intracochlear device, and two patients have been implanted with the Melbourne (Clark) 21-channel unit. All patients have had 11 months or more of experience with their cochlear prostheses. The results of a comprehensive audiologic battery which includes audiovisual and environmental tasks are presented. All implants provide significant improvement in speechreading and sound awareness. The findings to date suggest that there is strong correlation between top-down cognitive processing (as reflected by lip reading skills) and performance with cochlear implants.
The distribution and significance of hepatitis B surface antigen in a rural population in Kenya.
A rural population in Kenya was studied and a prevalence of HBsAg of 5-0% and an antibody prevalence of 50% in HBsAg in negative subjects has been found; 1-2% of the negative subjects converted to positive over a six-month period. A group of HBsAg positive subjects was compared with a matched group of HBsAg negative controls clinically in liver function tests and past medical history. No statistically significant differences were found between the two groups and neither group had experienced in the past significantly more skin scarification, injections or illness with jaundice. Both ad and ay subtypes occurred in the population. This is an unexpected and important finding, which gives scope for further detailed epidemiological studies in this population.
Hepatitis B antigen in viral hepatitis in West London.
During the first 12 months of a total population survey 249 patients were seen with viral hepatitis. A total of 215 of these were tested for hepatitis B antigen (HB Ag) by radioimmunoassay and 32 (15%) were positive.More than five times as many men (27) as women (5) were HBAg positive and 19 of the men were between the ages of 20 and 39 years. There were only four drug addicts among those tested, two of whom were positive, as were two of the four patients who were tattooed.Sixty out of 86 children (under 15 years) were tested for HBAg and none was positive.
Maternal behavior of undernourished mother rats.
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Inter-relations of folic acid and vitamin B 12 in drug-treated epileptic patients.
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Relation of serum to red cell folate concentrations in drug-treated epileptic patients.
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Folate metabolism in epileptic and psychiatric patients.
Serum and red cell folate levels and serum vitamin B(12) levels have been estimated in 33 normal controls; 34 epileptic outpatients, 19 of whom also suffered from psychiatric illness; 33 epileptic inpatients with psychiatric illness; and 30 non-epileptic inpatients with psychiatric illness. Significant lowering of serum folate and red cell folate levels was observed in epileptic patients with psychiatric illness, and a less significant fall in red cell folate levels was found in non-epileptic psychiatric patients. Serum folate levels less than 2·5 ng/ml. were found in two controls, seven outpatient epileptics, 29 inpatients, and 10 non-epileptic patients. Red cell folate levels less than 100 ng/ml. were found in two controls, nine outpatient epileptics, 23 inpatient epileptics, and seven non-epileptic patients. A significant correlation was found between serum and red cell folate values in control, epileptic, and non-epileptic patients. In the epileptic patients there was a significant association between low serum and red cell folate levels and the presence of psychiatric illness. The origin and possible significance of these findings are discussed.
Folic acid and anticonvulsants.
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Total bed management: the way forward in pressure sore prevention.
King's College Hospital, London, is the first trust to implement total bed management (TBM) to assist in the reduction and prevention of pressure sores. TBM is a new concept, whereby the tissue viability, manual handling and therapy needs of the trust are met at reduced costs through a partnership with a contractor. The introduction of a large number of electric bed frames and foam mattress replacements, with the availability of dynamic pressure-relieving equipment and a service agreement, has led to an expected trust saving of 86,000 Pounds in 1998/1999 and 100,000 Pounds in 1999/2000 onwards. This article outlines the perceived benefits of this approach.