Biomedical subjects
Publications and source records attributed to L Hallam.
A case of primary pulmonary hypoplasia in a term female neonate presenting with severe respiratory distress at birth is reported. Respiratory failure persisted and she died at 12 days of age. Primary pulmonary hypoplasia is a rare condition not associated with other maternal or fetal disorders.
OBJECTIVE: To evaluate a metal detector to diagnose swallowed radio-opaque metal foreign bodies (MFBs) in children, and whether they can detect non-radio-opaque MFBs. METHODS: In a prospective study, 231 children, who presented to the accident and emergency department with a history of swallowing MFBs, were evaluated by the metal detector as well as radiography to confirm and locate the presence or absence of MFBs. RESULTS: A definite history of swallowing a MFB by the child was given by 186 (81%) parents. The metal detector located MFBs in 183 children and radiographs confirmed radio-opaque MFBs in 181. In the remaining 45 (19%), when swallowing was suspected and not definite, both metal detector and radiography confirmed the presence of a MFB in only four. CONCLUSION: A high detection rate of swallowed MFBs was observed in this study, using a metal detector. It is also of value to detect non-radio-opaque MFBs like aluminium. The detection of MFBs is high when the history of swallowing is definite.
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Haemoptysis in otherwise healthy children is an uncommon event. Two cases of massive haemoptysis, subsequently requiring lobectomy, are discussed. In each case, foreign vegetable matter was identified despite previously normal bronchoscopy and minimal changes on chest radiograph.
BACKGROUND: Fine needle biopsy (FNB) in children has been slow to gain acceptance compared with the use of the technique in adults where it is regarded as standard clinical practice in screening significant lymphadenopathy and suspicious masses. We report our early experience with FNB in the paediatric population. METHODS: Fifty-two biopsies were performed between June 1991 and June 1993. The age of the children ranged from 6 months to 14 years (median 2 years, mean 5 years). RESULTS: A definite diagnosis on cytology alone was obtained in 67%. The pathologist was certain of malignant or nonmalignant potential in 79% (67% benign and 12% malignant) and unsure in 21% (17% benign and 4% malignant). There were no false positive or false negative diagnoses of malignancy. Surgical excision or biopsy was performed in 33%. Fine needle biopsy assisted in planning surgery in 12%. Surgery was necessary for a definite diagnosis in 21% and FNB assisted 42% of the patients to avoid surgery altogether. CONCLUSIONS: Fine needle biopsy is simple, minimally invasive and useful in the evaluation of children with suspicious lymph nodes and masses.
STUDY OBJECTIVE: The study aimed to determine the relative risk of being accepted for renal replacement treatment of black and Asian populations compared with whites in relation to age, sex, and underlying cause. The implications for population need for renal replacement therapy in these populations and for the development of renal services were also considered. DESIGN/SETTING: This was a cross sectional retrospective survey of all patients accepted for renal replacement treatment in renal units in England in 1991 and 1992. PATIENTS: These comprised all 5901 patients resident in England with end-stage renal failure who had been accepted for renal replacement therapy in renal units in England and whose ethnic category was available from the units. Patients were categorised as white, Asian, black, or other. Population denominators for the ethnic populations were taken from the 1991 census. The census categories Indian, Pakistani, and Bangladeshi were aggregated to form the denominator for Asian patients, and black Caribbeans, black Africans, and black others were aggregated to form the denominator for black patients. MAIN RESULT: Altogether 7.7% of patients accepted were Asian and 4.7% were black; crude relative acceptance rates compared with whites were 3.5 and 3.2 respectively. Age sex specific relative acceptance ratios increased with age in both ethnic populations and were greater in females. Age standardised acceptance ratios were increased 4.2 and 3.7 times in Asian and black people respectively. The most common underlaying cause in both these populations was diabetes; relative rates of acceptance for diabetic end-stage renal failure were 5.8 and 6.5 respectively. The European Dialysis and Transplant Association coding system was inaccurate for disaggregating non-insulin and insulin dependent forms. "Unknown causes" were an important category in Asians with a relative acceptance of rate 5.7. The relative rates were reduced only slightly when the comparison was confined to the district health authorities with large ethnic minority populations, suggesting that geographical access was not a major factor in the high rates for ethnic minorities. CONCLUSION: Acceptance rates for renal replacement treatment are increased significantly in Asian and black populations. Although data inaccuracies and access factors may contribute to these findings, the main reason is probably the higher incidence of end-stage renal failure. This in turn is due to the greater prevalence of underlying diseases such as non-insulin dependent diabetes but possibly also increased susceptibility of developing nethropathy. The main implication is that these populations age demand for renal replacement treatment will increase. This will have an impact nationally but will be particularly apparent in areas with large ethnic minority populations. Future planning must take these factors into account and should include strategies for preventing chronic renal failure, especially that due to non-insulin dependent diabetes and hypertension. The data could not determine the extent to which population need was being met; further studies are required to estimate the incidence of end-stage renal failure in ethnic minority populations.
OBJECTIVE: To determine the use and organisation of out of hours services in primary care. DESIGN: Telephone survey. SETTING: Family health services authorities in England and Wales. MAIN OUTCOME MEASURES: Rate of use of out of hours care, methods of provision, and role of authorities. RESULTS: 12-25% of authorities were unable to answer one or more key questions in the survey because of insufficient information. The mean number of night visits made per unrestricted principal per 1000 patients per year was 35.3. 13 of the 19 authorities with averages above 40 covered large towns or cities. 81 authorities had at least one commercial deputising service. In 46 metropolitan districts and one other district over 75% of general practitioners had consent to use a deputising service, although not all did so. Information on cooperation between practices was limited. 22 cooperatives were recognised by the authorities, nine were not officially recognised, and a further 13 were nearing institution. Only two cooperatives were in areas with extensive use of deputising services. CONCLUSION: Methods of providing out of hours care are changing, and without good information systems family health services authorities will not be able to monitor the effect on quality and cost effectiveness of care.
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Fundamental changes in the delivery of primary medical care outside normal surgery hours are under consideration in Great Britain. Published research into the provision and utilisation of out of hours services shows long term trends towards decreasing personal commitment among general practitioners and rising demand from patients for primary and hospital accident and emergency department care. Wide variations exist regionally, locally, and between practices. Previous studies, however, have been limited in scope and provide an inadequate basis for assessing the potential impact of change. The overall demand for care across all sources of provision cannot be measured: there is a lack of data on costs, and evaluative studies comparing alternative patterns of service delivery have rarely been undertaken. A period of experimentation and evaluation of a range of options should precede the wider adoption of any particular models.
Postal surveys were conducted among samples of patients in four practices to determine accessibility of surgeries and general practitioners by telephone. Over half of the respondents reported being unable to get through to the surgery on their first attempt. Significant differences between practices were related to the number of patients served by each incoming line. Although all of the general practitioners involved were accessible to patients by telephone, only half of the respondents knew this. Significant differences in awareness levels between practices were related to policies and methods of disseminating this information. Satisfaction with the help received from doctors by telephone was uniformly high, but patients were less satisfied with the process of contacting a doctor, particularly where receptionists questioned callers about their problem. It is suggested that practices review the adequacy of their telephone systems against a recommended standard of one incoming line per 2500 patients and consider how information about their telephone policies and services can be effectively communicated to patients. Reception staff may need additional guidance on managing telephone contacts with patients.
Few general practitioners have extensive daytime telephone contacts with patients. Forty nine general practitioners responding to a postal survey who reported handling a mean of nine or more calls a day were interviewed about their experiences. The nature of telephone contacts with patients and the organizational strategies employed to minimize disruption to surgeries were explored. Views on the rewards and frustrations of being accessible by telephone and its impact on other aspects of workload were also sought. Recommendations are made for practices contemplating extending telephone access for patients.
OBJECTIVES: To assess how accessible general practitioners are to patients by telephone and to examine the relations between organisation, number of lines, and number of patient-doctor calls. DESIGN: Postal survey of a random sample of general practitioners stratified by rural and urban practice areas, with differential sampling fractions. SETTING: General practices in England and Wales. SUBJECTS: 2000 general practitioners, of whom 1459 (74%) responded. MAIN OUTCOME MEASURES: Number of calls received by general practitioner a day, time reserved for patients' calls, and communication of availability of telephone contact. RESULTS: 1421 general practitioners said that they accepted non-emergency calls from patients during the day and 285 reported reserving specific times of the day for this purpose. 848 estimated that they received four or fewer patient calls a day. The number of calls was significantly related to reserving time for calls (p less than 0.001), informing patients that the doctor was accessible by telephone (p less than 0.00001), and the number of periods when calls were accepted (p less than 0.00001). On average there were 3659 patients per incoming line; the number of patients per incoming line rose significantly as practice size increased (p less than 0.00001). CONCLUSIONS: The apparent willingness of general practitioners to accept calls was not reflected in the number of calls received. Reserving time, increasing periods of availability, and publicising telephone access increased the number of doctor-patient telephone contacts. Line congestion may be a problem, and impartial advice and guidance on telephone organisation and line requirements would be helpful.
The glutathione S-transferases (GSTs) have been implicated in carcinogenesis and tumour drug-therapy resistance. In this study GST pi was the predominant isoenzyme in the fetal human kidney. It was present in differentiated epithelial structures but never in the primitive mesenchyme. By contrast most cases of Wilms' tumours showed GST pi in both epithelial structures and undifferentiated blastema. The level of expression, as assessed by immunostaining, was no more than moderate, and was generally higher in differentiated elements. In only one case was GST alpha found in Wilms' tumour. This study had demonstrated a difference between fetal kidney and Wilms' tumour blastema in terms of GST expression.
This paper reviews the role of the telephone in delivering primary health care. It highlights the wide differences between the UK and other countries, notably the USA, in knowledge of and experience with telephone care. The volume and nature of telephone contacts in family medicine are explored before focusing on calls which may be described as consultations, both in and out of office hours. Aspects of telephone consultations examined include the quality of care, the effectiveness of training programmes and the role of other health professionals. Important gaps in the literature are identified, including the lack of comparisons between telephone and face-to-face care in terms of the quality of process and outcomes and the lack of data on costs and benefits.
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Using data collected for a study of the process of care in a large urban area, the opportunity was taken to examine seasonal variations in consultation patterns. While overall numbers of consultations varied month by month, no seasonal pattern was found. The ratio between patient and doctor-initiated contacts remained stable throughout the year, as did the age, sex and social class of patients consulting. The proportion of consultations that took place in the home increased during the winter months. As expected, seasonal fluctuations in morbidity were most apparent in respiratory disorders, though a small number of non-respiratory problems showed similar variations. There was no discernible seasonal pattern to investigation, referral, and prescribing rates, though wide variation existed between individual general practitioners. The implications of these findings for the design of future studies are discussed.