Best practice communication strategy: Princess Alexandra Hospital.
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Biomedical subjects
Publications and source records attributed to J Robson.
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The direct effect of intratracheal (IT) administration of human major basic protein (MBP) on pulmonary inspiratory pressure (PIP), and the effect on agonist-induced change in PIP, were determined in anesthetized, ventilated guinea pigs. 500 micrograms MBP increased PIP from 24.1 +/- 4.3 to 49.8 +/- 7.4 cmH2O (p < 0.002, n = 10). Maximum PIP was achieved within 30 min after 500 micrograms MBP. The direct PIP response to 250 micrograms MBP was not different from vehicle. The PIP responses to intravenous (IV) acetylcholine (Ach) and 5-hydroxytryptamine (5-HT) were measured before and after administration of 250 micrograms MBP (n = 12). MBP caused a modest, but significant potentiation of the increase in PIP induced by 1, 3 and 10 micrograms/kg Ach (24, 32 and 28%, respectively, p < 0.02) and to 1 microgram/kg 5-HT (43% p < 0.02). We conclude that MBP at a dose that does not directly affect inspiratory pressure is capable of augmenting the PIP response to IV Ach and 5-HT in vivo.
To explore the impact of infertility on psychological functioning 130 couples presenting with primary infertility were assessed at their initial visit to an infertility clinic. Of these, 116 couples were assessed on a second occasion some 7-9 months later when in most cases the medical tests were complete. Measures of personality, psychopathology, perceived social support, sex role identity and marital state were obtained from both partners. The set was subsequently divided into five subgroups on the basis of the diagnosis made or the outcome (female cause, male cause, female and male cause, unexplained and pregnant). The results show little evidence of psychopathology in the sample, depression scores remained low throughout the period of investigation. The results also indicated stable marital relationships. Scores on tests of anxiety and psychiatric morbidity declined between the first and second assessment except in the case of men who were diagnosed with a fertility problem. The implications of these findings are discussed in the increased use of donor insemination which circumvents rather than treats the problem of male infertility.
A survey was carried out among 281 men and women aged between 30 and 64 years randomly selected from five general practices located in the inner London borough of Tower Hamlets, to determine the prevalence of risk factors for coronary heart disease. Smoking and obesity were both more pronounced in Tower Hamlets than in comparable national studies: 51% of men and 44% of women were smokers and 57% of these were smoking 20 or more cigarettes per day. A body mass index of 30 or more was present in 18% of men and 10% of women and a body mass index of 25 or more in 71% of men and 49% of women. Two or more risk factors for coronary heart disease (smoking and/or hypertension and/or raised cholesterol levels) were present in 25% of men and 22% of women. For every person known by their general practitioner to have established cardiovascular disease, there were an additional two people also at risk on the basis of multiple risk factors. In this inner city population the prevalence of cardiovascular risk, for women as well as men, has major resource and organizational implications for primary care. A strategy for change requires action based on graded multiple risks for both men and women.
The visual assessment of erythema induced by ultraviolet radiation (UVR) involves a comparison of the irradiated site with surrounding nonirradiated skin. By viewing the skin through plastic filters of varying shades of brown to simulate different degrees of pigmentation and under either incandescent or fluorescent lighting, we were able to examine the influence of pigmentation and illumination on the perception of erythema. Illuminating the skin with either light source at the same illuminance did not affect the determination of the minimal erythema dose (MED). Likewise, the range of pigmentation that may occur in Caucasian skin had little or no effect on the perception of the MED compared with white, untanned skin. However, when the skin was viewed through dark brown filters that approximate the absorbance of Negro skin, erythema was only perceived at sites that had been irradiated with more than about twice the MED.
Twenty-four individuals with impaired speech (anarthria or dysarthria) were compared on tests of receptive language to a control group with normal speech. All subjects were cerebral-palsied and groups were matched on age and nonverbal ability. The speech-impaired subjects performed less well than controls on a phoneme discrimination task in which they were required to judge whether pairs of nonwords were the same or different. They were also impaired relative to controls on a receptive vocabulary test, but not in understanding of grammatical structure. One year later, phoneme discrimination skills were reassessed in this sample, using another same-different task, plus a new task in which subjects were required to judge if the name of a picture was spoken correctly or altered by one sound. Speech-impaired subjects performed as well as controls on the word judgment task, indicating that they can discriminate phoneme contrasts adequately. However, the same-different task again resulted in highly significant differences between speech-impaired and control groups. It is concluded that poor performance on the same-different task reflects weak memory for novel phonological strings, rather than impaired phoneme perception. It is proposed that retention of unfamiliar words is facilitated by overt or covert repetition, so individuals who cannot speak fluently have difficulty remembering nonwords. This explanation can account both for the poor performance of speech-impaired subjects on the same-different task, and for their selective deficit in vocabulary acquisition.
The spectral transmission of ultraviolet radiation was measured through natural textiles (cotton, wool, silk) and human-made textiles (acrylic, viscose, polyester). Each textile exhibited a characteristic spectral transmission curve, but the protection afforded by a given fabric depended more on the nature of the weave than on the particular type of textile.
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Two inner city general practices in east London jointly provide care outside normal working hours without using deputising services for about 14,000 patients. The statistics on workload were reviewed for 1987 and 1988. An overall rate of face to face consultations of 4.1 per patient per year was recorded, there being 115,965 consultations over two years for a mean list size of 14,174 patients. Four per cent (4737) of such consultations were outside normal working hours. The annual rate of visiting outside normal hours was 128.1 per 1000 patients in 1987 (1793 visits) and 131.5 per 1000 in 1988 (1888 visits). The rates of night visiting were 18.8 (262 visits) and 18.9 (271 visits) per 1000 patients in 1987 and 1988 respectively. Only 24% of all the requests for medical help out of hours (1483/6220) were dealt with by advice given on the telephone. The high rates of consultation outside normal working hours with only a small proportion being dealt with on the telephone alone may be explained by indices of deprivation. Local rotas for out of hours work are a good compromise between meeting the needs of patients and doctors in deprived areas, but there are financial implications for inner cities.
OBJECTIVE: To assess whether an organised programme of prevention including the use of a health promotion nurse noticeably improved recording and follow up of cardiovascular risk factors and cervical smears in a general practice that had access to computerised cell and recall. DESIGN: Randomised controlled trial. SETTING: General practice in inner London. PATIENTS: All 3206 men and women aged 30-64 registered with the practice. INTERVENTION: The intervention group had their risk factors ascertained and followed up by the health promotion nurse and the general practitioner, whereas those in the control group were managed by the general practitioner alone. END POINT: Recording and follow up of blood pressure and cervical smears after three years. Recording of smoking, family history of ischaemic heart disease, and serum cholesterol concentrations were also examined. MEASUREMENTS AND MAIN RESULTS: When the trial was stopped after two years the measurements of blood pressure in the preceding five years were 93% (1511/1620) v 73% (1160/1586) (95% confidence interval for difference 17.5 to 22.7%) for intervention and control groups respectively. For patients with hypertension the figures were 97% (104/107) v 69% (80/116) (18.2 to 38.2%). For women the proportion who had had a cervical smear in the preceding three years were 76% (606/799) v 49% (392/806) (22.5 to 31.9%). Recording of smoking, family history of ischaemic heart disease, and serum cholesterol concentrations was also higher in the intervention group compared with the control group. CONCLUSION: An organised programme, which includes a nurse with specific responsibility for adult prevention, is likely to make an important contribution to recording of risk factors and follow up of those patients with known risks.
The predominance of coagulase-negative staphylococci as normal skin flora is thought to be a factor in their association with episodes of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis. We investigated the prevalence of peritonitis-associated strains on the skin of 28 patients undergoing peritoneal dialysis. Coagulase-negative staphylococci were the most frequently isolated organisms, comprising 47% of peritoneal dialysis fluid isolates and 59% of body site isolates. A total of 142 coagulase-negative staphylococci were speciated, tested for their antimicrobial sensitivity and slime production, and identified by phage typing and plasmid-profile analysis. Staphylococcus epidermidis was the most commonly identified species from both peritoneal dialysis fluid (73%) and body sites (53%). Multiple antibiotic resistance was common, and the greater proportion of isolates were resistant to methicillin; 63.6% of peritoneal dialysis fluid isolates and 61.7% of body-site isolates. S. haemolyticus isolates were significantly more resistant to methicillin than other species. By phage typing and plasmid-profile analysis it was shown that peritonitis was rarely caused by skin-colonizing strains. In only 3 of 14 patients were peritonitis-associated strains isolated as skin colonizers, and no patients developed peritonitis due to organisms previously isolated as skin colonizers.
Previous work has shown that children with motor speech disorders (dysarthria) have no particular difficulty in spelling non-words containing sounds that they cannot produce accurately in their own speech. This suggests that subvocal articulation is not implicated in generating a graphemic representation from a phonological string. However, it could be argued that, although severely unintelligible, dysarthric individuals may be able to use their own articulation as a basis for translating between phonemes and graphemes. In this study we investigated spelling of words and non-words in cerebral palsied individuals, including speechless (anarthric) as well as dysarthric subjects. Although spelling abilities of these individuals were below control levels, there was no evidence that different processes were used, and one anarthric individual achieved perfect performance in spelling a list of non-words which included consonant clusters. It is concluded that spelling by the 'indirect' route can be achieved in the absence of any articulation.
THE STUDY COMPARED TWO SCHEMES OF BOOKING FOR ANTENATAL CARE: booking at a health centre by general practitioners in conjunction with a hospital consultant or booking in a hospital clinic by hospital staff. the health centre scheme reduced the proportion of women booking late at 16 or more weeks gestation from 44% to 11% and at 20 weeks or more from 28% to 6%. There was no improvement in delay in booking owing to late confirmation of pregnancy. The benefits of this scheme were due to improved attendance and reduced delays in booking among women who confirmed pregnancy before 16 weeks gestation.
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