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Biomedical subjects

K Radcliffe

Publications and source records attributed to K Radcliffe.

17 recordsLinked to original sources
PubMed2004

Developing national outcome standards for the management of gonorrhoea and genital chlamydia in genitourinary medicine clinics.

BACKGROUND: Measuring clinical performance within a framework of clinical governance is increasingly important for monitoring improvements in patient care. Standards for quality indicators must, however, be achievable and evidence based. We describe an approach to the development of national standards for measuring outcomes of care for gonorrhoea and genital chlamydia in genitourinary medicine clinics. METHODS: Two standards for each infection, one reflecting quality of case management and one reflecting partner management were chosen by consensus. A systematic review of published and unpublished UK studies about gonorrhoea and chlamydia management was carried out and weighted averages calculated for each parameter, stratified by location. Genitourinary medicine practitioners around the country were also asked for their opinion about desirable values for each standard and the results compared. Variability in performance between centres was examined using Shewhart's control charts. RESULTS: We identified 17 reports about gonorrhoea outcomes and 14 about chlamydia. There was marked heterogeneity in results according to geographical location and different standards were set for clinics in and out of London. Opinions from practitioners suggested much higher standards than the values obtained from the systematic review. There was evidence for special cause variation related to management of gonorrhoea and chlamydia in London clinics. CONCLUSIONS: Standards set using expert opinion are unrealistic when compared to evidence of what is achievable. Evidence based methods should therefore be used to derive outcome standards for case management gonorrhoea and chlamydia. The control chart method identified clinics where investigation to find reasons for special cause variation in performance should be undertaken to change practice.

Ambulatory Care↗
PubMed2004

Antiviral treatment of genital herpes.

A review of the randomized, controlled trials in the literature on the treatment of genital herpes infection with aciclovir, famciclovir and valaciclovir. Common clinical questions encountered by physicians, such as the effect of antivirals on symptoms, healing, aborting attacks and subsequent recurrences, are addressed. There is very little comparative data between the three licensed drugs but the little data that there is shows no difference in efficacy, tolerability and toxicity between aciclovir, valaciclovir or famciclovir when taken orally. Choice of therapy would then depend on convenience of dosing and cost.

2-Aminopurine↗
PubMed2004

The role of urethral samples in the diagnosis of gonorrhoea in women.

We studied the value of carrying out urethral samples in women to diagnose gonorrhoea. All cases of genital gonorrhoea in women were identified (between 1 October 2000 and 30 September 2001) at the Whittall Street Clinic and the genitourinary medicine department at the Coventry and Warwickshire Hospital. Two hundred and twenty-four cases of female urethral gonorrhoea were identified. In 20 cases (6.3%) the urethra was the sole site of the infection. At the Whittall Street Clinic, we had to carry out 643 urethral samples in order to treat one additional case of gonorrhoea. On the other hand, 1204 urethral samples were requested to treat one additional case of female gonorrhoea at the Coventry and Warwickshire Hospital. In both units, use of the Gram-stained urethral smear permitted early treatment in only 1.8% of cases of genital gonorrhoea. Units with low prevalence of gonorrhoea should consider abandoning urethral samples for the diagnosis of gonorrhoea in women.

Adolescent↗
PubMed2004

Is telephone follow-up as good as traditional clinic follow-up in achieving the proposed national outcome standards for chlamydia management?

A retrospective review of 400 cases of genital chlamydia managed with a traditional clinic follow-up was compared to 400 cases with a telephone follow-up appointment. We satisfactorily treated more patients with the telephone follow-up appointment than with a traditional clinic follow-up (204 [51%] vs 121 [30%]; P <0.0001). We also satisfactorily treated more partners with the telephone follow-up system than a traditional clinic appointment system (0.57 vs 0.45 contacts per case; P =0.0006). The introduction of the telephone follow-up appointment system in the clinic increased the number of patients and contacts of patients successfully managed for genital chlamydial infection. Our findings should lead to increased research and adoption of different methods of follow-up and help develop proper outcome standards.

Adolescent↗
PubMed2000

Relation between information and advice provision to male GUM clinic attendees and sexual orientation and ethnic group.

OBJECTIVES: To examine whether the provision of advice and information to male genitourinary medicine (GUM) clinic attendees was related to their reasons for attendance, ethnicity, or sexual orientation. METHOD: Cross sectional survey of men attending a large city centre GUM clinic. Data were collected using an anonymous subject completed questionnaire. RESULTS: Of the 302 men recruited, 72% described themselves as white and 85% reported only female sexual partners. Information and advice provision were generally found to reflect reason for attendance--for example, those attending with a concern about "an STD or urinary problem" were more likely to report advice and information on NSU/chlamydia, herpes, gonorrhoea, or syphilis than those attending without such concerns. For those attending with a concern about HIV less than half (42%) reported receiving advice and information about HIV. The reasons for attendance were found to vary with ethnicity (black men were more likely to attend for a "check up," and less likely to attend about HIV or with genital warts than white men) and sexual orientation (those with male partners were more likely to attend about HIV or hepatitis B than those with only female partners); there were corresponding variations in the provision of advice and information. CONCLUSIONS: The clinic was generally providing advice and information appropriate to the reasons for attendance and this reflected variations in such needs with ethnicity and sexual orientation. The provision of advice and information about HIV could be more comprehensive.

Adolescent↗
PubMed1998

Laparoscopic Swenson Pull-through Procedure for Hirschsprung's Disease.

The introduction of a new procedure into the operating room is always a challenge that requires careful planning and teamwork. This article describes the pathophysiology of Hirschsprung's Disease, the perioperative nursing care required and the operative technique of the Laparoscopic Swenson Pull-Through Procedure.

Hirschsprung Disease↗
PubMed1997

Boron-containing polyamines as DNA targeting agents for neutron capture therapy of brain tumors: synthesis and biological evaluation.

Three series of new boron-containing spermidine/spermine (SPD/SPM) analogues have been synthesized: N1- and N5-(4-carboranylbutyl) SPD/SPM derivatives (SPD-1, SPD-5, SPM-1, SPM-5); N1,N10-diethyl-N5-(4-carboranylbutyl)spermidine (DESPD-5), N1,N14-diethyl-N5-(4-carboranylbutyl)spermine (DESPM-5); and N5,N10-bis(4-carboranylbutyl)spermine (SPM-5,10). In vitro studies using rat F98 glioma cells have shown that these polyamines retain the ability to displace ethidium bromide from calf thymus DNA and are rapidly taken up by F98 glioma cells. However, their cytotoxicities, especially those with terminal N-substituted (SPD-1, SPM-1) boron compounds, are greater than those of SPD/SPM. Nevertheless, the groundwork has been created for a new class of boron-containing compounds that maybe useful for boron neutron capture therapy of tumors.

Animals↗
PubMedDate not supplied

Evaluation of nitrogen utilization in patients receiving total parenteral nutrition.

This two phase study evaluates nitrogen utilization by the body as a function of fixed caloric intake but different nitrogen loads. Nitrogen use by the body was estimated from measures of nitrogen balance, net protein utilization, and urea accumulation rate. Phase 1 of this study included 411 measurements of nitrogen use in 120 patients assigned, according to clinical condition, to receive one of the four following therapies: dextrose (D) 25%, amino acids (CAA) 4.25% (Group 1); D 35%, CAA 4.25% (Group 2); D 25%, CAA 21.3% (Group 3); or D 35%, CAA 21.3% (Group 4). Forty patients in Phase 2 were assigned in a randomized, prospective, double blind manner, to receive one of the following regimens; D 35%, CAA 2.75% (Group 5); D 25%, CAA 2.75% (Group 6); D 35%, CAA 4.25% (Group 7); or D 25%, CAA 4.25% (Group 8). In Phase 1, positive nitrogen balance was achieved with the exception of Group 3 where neither the estimated caloric nor nitrogen needs of the patients were met. It appeared that protein utilization was maximal in patients receiving the therapy of highest calorie:nitrogen ratio (Group 4). Phase 2 patients achieved positive nitrogen balance to the same extent (p greater than 0.05) and although net protein utilization improved from 53 to 71%/d as the calorie:nitrogen ratio was increased, the differences were not significant (p greater than 0.05). There was a significant improvement in total iron binding capacity in Phase 2 patients (p less than 0.01) that was most prominent at the lower concentrations of amino acids (high cal:n ratio) (Groups 5 and 6). Smaller amounts of nitrogen appear adequate in producing a positive nitrogen balance and may be better utilized in hospitalized patients if the patients' caloric requirements are achieved.

Adolescent↗
PubMedDate not supplied

Anonymized sero-survey of HIV in a genitourinary medicine clinic population.

An anonymized sero-survey of the prevalence of HIV antibody was performed at an inner city Genitourinary medicine clinic in Birmingham. In 1991 8686 patients undergoing routine serological syphilis tests were anonymously tested for HIV antibodies once during the year. Demographic information was recorded for each sample but they were otherwise unlinked. There were 31 samples which tested positive for anti-HIV 1 from this group compared with 13 diagnosed by concomitant voluntary named testing. Sero-prevalence rates of 0.17% for women and heterosexual men and 4.37% for homosexual/bisexual men were found. No drug users tested positive. The survey provided evidence of occult disease outside the recognized risk behaviour patterns of homosexual men and injecting drug users outside London.

AIDS Serodiagnosis↗