Biomedical subjects

K Melvin

Publications and source records attributed to K Melvin.

6 recordsLinked to original sources

PubMed2000

Promoting effective practice in secondary care.

BACKGROUND: This qualitative study aimed to explore the views of key stakeholders regarding the role that public health professionals have or should have in the provision of effective health care within the National Health Service. METHODS: A national (England) questionnaire survey generated a sample for qualitative telephone interviews and two site case studies. The interviews were conducted in three stages: first, 27 interviews were based on assessed reported levels of organizational activity, including non-respondents; next, views in six areas were consolidated by extra interviews; finally, two extra areas were visited for individual and group interviews. The interviews were analysed for salient themes. RESULTS: There was a widespread view that public health had not delivered its potential. Many Trusts currently wanted public health to have influence over commissioning, provide health needs assessments and epidemiological skills, and provide a strategic focus and unbiased advice. Evaluation of actual activity varied widely; local history and congruent personalities seemed to be associated with perceived success. In some cases there was mutual suspicion between Health Authorities and Trusts. Public health was often perceived by Trusts to have been marginalized. This perception was not shared by Public Health Consultants, who highlighted lack of resources as a reason for lack of involvement. The contribution of public health professionals working in Trusts was highly regarded. Barriers included overcoming initial prejudice and combating isolation within Trusts. There were four categories of response in respect of the potential future role for public health in implementing effective health care: no role; collaborative working between Health Authority Public Health Departments and Trusts; deployment of public health workers within Trusts, and an undecided group. Overall, the skills of public health, especially strategic vision and population perspectives, were seen as valuable but as yet unrealized. CONCLUSIONS: Public health skills (but not necessarily professionals) may be valuable in implementing effective health care in Trusts. However, public health professionals must refocus and market their skills to Trusts if the discipline is to play a key role in this task.

Attitude of Health Personnel↗

PubMed1987

Successful surgical repair in a patient with mitral stenosis, calcified left atrium and severe tricuspid regurgitation with a giant right atrium.

Successful mitral valve replacement and tricuspid annuloplasty were performed on a 66-year-old woman who had a calcified left atrium, giant right atrium, calcified mural thrombus and normal pulmonary pressures. Successful repair in such cases depends on an adequate preoperative investigation and a surgical approach tailored to the individual.

Aged↗

PubMed1986

Obstructive sleep apnea and cardiac index.

Seventeen men (age range, 21 to 58 years) with severe obstructive sleep apnea syndrome (OSAS) documented by nocturnal polysomnography underwent hemodynamic investigations during sleep. We studied the evolution of the cardiac index during apneic events in both NREM and REM sleep using the thermodilution technique. Regardless of the patient's age, the sleep state, or the mechanism inducing the OSAS, the cardiac index decreased significantly from baseline during an apneic event and increased significantly from baseline at the resumption of ventilation.

Adult↗

PubMed1984

Cyclical variation of the heart rate in sleep apnoea syndrome. Mechanisms, and usefulness of 24 h electrocardiography as a screening technique.

400 sleep-apnoeic patients with an intact autonomic nervous system underwent twenty-four-hour electrocardiography with simultaneous polygraphy recording at night. At onset of sleep apnoea all showed progressive bradycardia, followed by abrupt tachycardia on resumption of breathing. The electrocardiographic pattern, which is identifiable by computer analysis, can be used as a screening tool for sleep apnoea; it was not seen in controls without sleep apnoea syndrome. A subgroup of patients with sleep apnoea and impairment of autonomic nervous control of the heart (heart transplants, autonomic neuropathy, Shy-Drager syndrome) did not show the cyclical heart rate pattern. In obstructive sleep apnoeic patients with normal autonomic nervous function, atropine sulphate blocked the pattern by eliminating the bradycardia component, while 100% oxygen, even at high rates of administration, caused only moderate blunting of the heart rate variation. The electrocardiographic changes observed in sleep apnoea syndrome are therefore mediated by the autonomic nervous system; hypoxia is not the only factor involved.

Activity Cycles↗

PubMed1980

Entrapment of the popliteal artery.

Popliteal artery entrapment is a rare but recognized cause of vascular insufficiency of the lower extremity. The authors describe the condition in a 26-year-old man. Diagnosis depends on arteriographic demonstration of the lesion. Treatment is surgical and should consist of either a bypass procedure or excision with graft interposition. Acute onset of peripheral vascular symptoms in a young person should arouse suspicion of such a lesion.

Adult↗

PubMed1979

Dietary fibre and the irritable bowel syndrome.

The dietary fibre intake of 25 patients with the irritable bowel syndrome was assessed by dietary recall over one week for the period before onset of symptoms, at diagnosis and after six months treatment with bran and a fibre-rich diet, and compared with controls matched for age and sex. Mean intake of patients fell from 20.2 g per day before onset of symptoms to 17.8 g at diagnosis (n.s.), when it was significantly less than the controls' intake of 22.6 g (P less than 0.01). The 20 patients who improved with treatment increased their intake from 18.9 g to 24.8 g (P less than 0.02); the five patients who did not improve did not increase their intake significantly (13.5 g to 15.6 g).

Cellulose↗