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Biomedical subjects

M A Mullee

Publications and source records attributed to M A Mullee.

At least 55 records · Page 3Linked to original sources
PubMed1992

Correlates of asthma morbidity in primary care.

OBJECTIVES: To explore the morbidity of patients diagnosed as asthmatic in general practice, to examine the determinants of this morbidity, and to derive a simple morbidity screening tool for use in primary care. DESIGN: Patient interviews, lung function measurements, and data extraction from general practice case notes. SUBJECTS: 300 asthmatic patients aged 5 to 65 years randomly selected from the repeat prescribing registers of three general practices in the Southampton area. MAIN OUTCOME MEASURES: Reported morbidity using a calculated index based on three questions (Are you in a wheezy or asthmatic condition at least once per week; Have you had time off work or school in the past year because of your asthma; Do you suffer from attacks of wheezing during the night?); mean forced expiratory volume in one second and mean peak expiratory flow (over a seven day period); diurnal variation in peak flow; and the relation of the morbidity index to lung function. RESULTS: Mean forced expiratory volume in one second was 67% predicted (SD 18.4), mean peak expiratory flow was 80% predicted (SD 18.9), and mean diurnal variation was 10% (SD 7.7). 76 subjects were classified as having low morbidity, 95 medium, and 125 high. The morbidity index was significantly associated with forced expiratory volume in one second, mean peak expiratory flow rate, and diurnal variation (p less than 0.05); it was not significantly associated with inhaler technique or use of prophylaxis. CONCLUSIONS: There was a large burden of persisting morbidity across all ages of patients diagnosed as asthmatic in the three well resourced practices studied. The use of the morbidity index may help to target the asthmatic patients needing more attention by concentrating on those reporting medium to high morbidity.

Absenteeism↗
PubMed1992

The prevalence of diabetic distal sensory neuropathy in an English community.

The prevalence of lower limb neuropathy was determined in a known diabetic population. From a general population of 97,034 subjects, a total of 1150 diabetic patients were identified of whom 1077 (93.7%) were reviewed. Neuropathy was defined as symptoms plus one abnormal physical finding, or two abnormal physical findings. An age- and sex-matched non-diabetic control group of 480 individuals was also examined by the same single observer. The prevalence of neuropathy was 16.3 (95% CI 14.6-19.0)% in diabetic patients and 2.9 (95% CI 1.4-4.4)% in non-diabetic subjects, yielding a prevalence odds of 6.75 (95% CI 3.87-11.79), p less than 0.001. In Type 1 diabetes, the prevalence was 12.7 (95% CI 8.0-17.6)% and in Type 2 diabetes 17.2 (95% CI 15.9-18.5)%. After adjusting for age, the difference was not significant (odds ratio (OR) 1.60 (95% CI 0.95-2.76)). The prevalence of neuropathy increased with age in diabetic and non-diabetic subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

The distribution and severity of diabetic foot disease: a community study with comparison to a non-diabetic group.

A surveillance programme was undertaken to identify all diabetic patients with foot disease in a defined population with the same age and sex structure as that of the UK. Of 1150 diabetic patients identified, 1077 were reviewed either at home or in hospital. The presence of foot deformity, amputation, and foot ulceration was determined. The site, depth, and duration of ulcers were recorded and any previous ulceration noted. All feet with ulcers were X-rayed. A non-diabetic comparison group of 480 age- and sex-matched individuals were also examined by the same observer. The prevalence of past or present foot ulceration was 7.4 (95% CI 5.8-9.0)% in diabetic patients and 2.5 (95% CI 1.1-3.9)% in the non-diabetic group, yielding an odds ratio of 2.94 (95% CI 1.58-5.48) (p less than 0.001) for the occurrence of foot ulceration in diabetic patients. Of the ulcers found on examination, 39.4% were neuropathic, 24.2% were vascular, and 36.4% were mixed. Multiple logistic regression analysis of selected variables revealed that duration of diabetes, absent light touch, impaired pain perception, absent dorsalis pedis pulse, and the presence of any retinopathy were significant predictors of the presence of foot ulcers. The prevalence of amputation in diabetic patients was 1.3 (95% CI 0.6-2.0)%, but there were no amputations in the non-diabetic group.

Adult↗
PubMed1992

The prevalence, detection, and epidemiological correlates of peripheral vascular disease: a comparison of diabetic and non-diabetic subjects in an English community.

A cross-sectional study was performed to investigate the distribution, methods of detection, and potential risk factors for peripheral vascular disease in a diabetic population with comparison to an age and sex matched non-diabetic group. The population came from a geographically defined area consisting of 10 general practices (total list size 97,034) and covered rural and urban districts of East Dorset. Peripheral vascular disease was defined as an ankle/brachial Doppler pressure ratio of 0.9 or less. Of the diabetic subjects reviewed, 864 were classified as having Type 2 diabetes and 213 Type 1 diabetes. The prevalence of peripheral vascular disease in Type 1 diabetes was 8.7% (95% CI 4.9-12.5) and in Type 2 diabetes 23.5% (95% CI 20.5-26.5), which after adjusting for age was not significantly different (odds ratio 1.5, 95% CI 0.8-2.7, p = 0.18). There was no difference in the frequency of symptomatic peripheral vascular disease or the site of occlusion between diabetic and non-diabetic subjects with peripheral vascular disease. Age, cerebrovascular disease, coronary artery disease, glucose, body mass index, and cholesterol in Type 2 diabetes and age and proteinuria in Type 1 diabetes were significant predictors of peripheral vascular disease. In the non-diabetic group, age and cigarettes smoked were significant variables. These findings suggest that clinical features of peripheral vascular disease in diabetic and non-diabetic subjects are similar but risk determinants may be different.

Adult↗
PubMed1992

A longitudinal study of baseline FEV1 and bronchial responsiveness in patients with asthma.

The effect of initial airway calibre on the response to bronchial provocation is unclear. Theoretically, geometric relationships within the airways might influence the measurement of responsiveness, particularly since a given change in calibre will produce a disproportionately greater reduction in flow in airways which are already narrowed. We have examined the relationship between serial measurements of prechallenge forced expiratory volume in one second (FEV1) and responsiveness to methacholine (PD20) in 8 children and 12 adults with asthma. Measurements were made every 2-3 wks for 12-18 months and all patients kept a daily record of symptoms and twice daily measurements of peak expiratory flow (PEF). Spearman's rank correlation coefficient (rho) for the relationship PD20 versus pre-challenge FEV1 was derived for each patient and varied widely within the group (range -0.22 to 0.73, mean 0.31); the strength of this correlation was not related to a patient's mean FEV1 % predicted, but was related to the degree to which PD20 and pre-challenge FEV1 themselves reflected concurrent asthma severity (mean morning PEF and mean symptom scores for the three days around each test). This suggests that the observed relationship between pre-challenge FEV1 and PD20 may be due less to the influence of airway geometric factors, which might be expected to be present in all patients, but rather that pre-challenge FEV1 is reflecting the severity of the underlying disease. Larger studies will be needed to test this hypothesis further.

Adolescent↗
PubMed1991

Audit of the effect of a nurse run asthma clinic on workload and patient morbidity in a general practice.

The aim of this study was to assess the effect of a nurse run asthma clinic on practice workload and the morbidity of patients in a four partner general practice. One hundred and fifteen asthmatic patients were studied and comparisons were made between the 12 months prior to the introduction of the clinic and the first 12 months after the clinic started. Morbidity was measured in terms of: the number of courses of oral steroids, the number of emergency salbutamol nebulizations, and the number of days lost from work or school. The number of consultations with the general practitioners were recorded. The repeat prescribing register was also monitored throughout the study to examine the effect of the clinic on prescribing in the practice. Consultations with general practitioners fell from a total of 818 to 414 during the study period (P less than 0.001). This was offset by 496 consultations with the nurse in the first 12 months of the clinic. As a result of attending the nurse clinic significant reductions (P less than 0.01) were found in the patients' requirements for courses of oral steroids, acute nebulizations and days lost from work or school. The results for the 46 children were similar to those for the 69 adults, confirming that the asthma clinic was effective for all ages. The clinic coincided with an increase in the number of patients receiving regular bronchodilator therapy and prophylactic medication. Eighty per cent of patients had their medication modified as a result of attending the clinic. The cost of prescribing remained remarkably stable.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Inhalation↗
PubMed1990

Evaluation of peak flow and symptoms only self management plans for control of asthma in general practice.

OBJECTIVE: To compare a peak flow self management plan for asthma with a symptoms only plan. DESIGN: Randomisation to one of the self management plans and follow up for a year. SETTING: Four partner, rural training practice in Norfolk. SUBJECTS: 115 Patients (46 children and 69 adults) with asthma who were having prophylactic treatment for asthma and attending a nurse run asthma clinic. MAIN OUTCOME MEASURES: The number of doctor consultations, courses of oral steroids, and short term nebulised salbutamol treatments and the number of patients who required doctor consultations, courses of oral steroids, and short term nebulised salbutamol. RESULTS: Both self management plans produced significant reductions in the outcome measures but there were no significant differences in the degree of improvement between the groups. The results were similar for children and adults. The proportions of patients requiring a doctor consultation fell from 98% (50/51) to 66% (34/51) in the peak flow group and from 97% (62/64) to 53% (34/64) in the symptoms only group and the proportions requiring oral steroids from 73% (34/46) to 47% (21/46) and 52% (31/60) to 12% (7/60). The median number of doctor consultations was reduced from 8.0 to 2.0 in the peak flow group and from 4.5 to 1.0 in the symptoms only group. CONCLUSIONS: The peak flow meter was not the crucial ingredient in the improved illness of the two groups. Teaching patients the importance of their symptoms and the appropriate action to take when their asthma deteriorates is the key to effective management of asthma. Simply prescribing peak flow meters without a system of self management and regular review will be unlikely to improve patient care.

Administration, Oral↗
PubMed1990

Measuring peak expiratory flow in general practice: comparison of mini Wright peak flow meter and turbine spirometer.

OBJECTIVE: To compare measurements of the peak expiratory flow rate taken by the mini Wright peak flow meter and the turbine spirometer. DESIGN: Pragmatic study with randomised order of use of recording instruments. Phase 1 compared a peak expiratory flow type expiration recorded by the mini Wright peak flow meter with an expiration to forced vital capacity recorded by the turbine spirometer. Phase 2 compared peak expiratory flow type expirations recorded by both meters. Reproducibility was assessed separately. SETTING: Routine surgeries at Aldermoor Health Centre, Southampton. SUBJECTS: 212 Patients aged 4 to 78 presenting with asthma or obstructive airways disease. Each patient contributed only once to each phase (105 in phase 1, 107 in phase 2), but some entered both phases on separate occasions. Reproducibility was tested on a further 31 patients. MAIN OUTCOME MEASURE: 95% Limits of agreement between measurements on the two meters. RESULTS: 208 (98%) Of the readings taken by the mini Wright meter were higher than the corresponding readings taken by the turbine spirometer, but the 95% limits of agreement (mean difference (2 SD] were wide (1 to 173 l/min). Differences due to errors in reproducibility were not sufficient to predict this level of disagreement. Analysis by age, sex, order of use, and the type of expiration did not detect any significant differences. CONCLUSIONS: The two methods of measuring peak expiratory flow rate were not comparable. The mini Wright meter is likely to remain the preferred instrument in general practice.

Adolescent↗
PubMed1990

Prognostic index for the development of liver metastases in patients with colorectal cancer.

The incidence of synchronous and metachronous liver metastases in patients with colorectal cancer is extremely high. Approximately 25 per cent of patients will have overt liver metastases at the time of presentation, and in the remainder up to 40 per cent will eventually develop liver metastases. In an attempt to obtain a prognostic index for the prediction of those patients most likely to develop liver metastases, 134 patients with primary colorectal cancer but without overt liver metastases at initial presentation were followed up for between 5-10 years. Regular liver scans were performed and the presence of liver metastases observed. A total of 47 patients developed liver metastases. Those preoperative variables related to the subsequent development of liver metastases were sex, log10 serum alkaline phosphatase level and Dukes' classification. A prognostic index using these parameters has been calculated.

Alkaline Phosphatase↗
PubMed1990

Prospective randomized controlled trial of hepatic arterial embolization or infusion chemotherapy with 5-fluorouracil and degradable starch microspheres for colorectal liver metastases.

Survival benefit from hepatic artery embolization (HAE) or hepatic arterial infusion chemotherapy (HAI) in patients with unresectable colorectal liver metastases has not previously been assessed in a randomized controlled trial. Sixty-one patients were randomized, 20 to receive no treatment, 22 to receive HAE, and 19 to receive HAI with 5-fluorouracil and degradable starch microspheres. Both treatments were acceptable to the patients in terms of low treatment morbidity rate. Median survival from diagnosis of metastases was 9.6 months for controls, 8.7 months for the HAE group and 13.0 months in the HAI group. There was no apparent survival benefit for the HAE group. The increased survival in the HAI group was observed in all the subgroups analysed but failed to reach statistical significance. The greatest observed benefit was achieved in the subgroup with less than 50 per cent hepatic replacement with tumour at presentation (median survival from diagnosis 10.0 months for controls, 10.2 months for HAE and 23.6 months for HAI); 36 per cent of patients developed extrahepatic disease recurrence. No significant benefit has been shown from either HAE or HAI, but a more carefully selected group of patients with only low volume hepatic disease may benefit from HAI therapy.

Adolescent↗
PubMed1990

A controlled trial of community based coronary rehabilitation.

Two hundred patients who had suffered an acute myocardial infarction 4-6 weeks before entered a randomised controlled trial of exercise treatment at a community sports centre supervised by a general practitioner. Eighty one per cent of the treatment group continued to exercise until they returned to work and 73% completed three months' exercise. There were no serious complications of the exercise course. The prevalence of angina pectoris fell by 10% in the treatment group but rose by 60% in the control group. The perceived energy level rose by significantly more in the treatment group than in the controls. The rise in predicted maximum oxygen uptake was significantly greater in the treatment group than in the control group as was the reduction in the double product (a reflection of myocardial workload) at peak exercise. Coronary rehabilitation in the community can be both safe and effective.

Adult↗
PubMed1989

Nonspecific bronchial reactivity and its relationship to the clinical expression of asthma. A longitudinal study.

The contribution of nonspecific bronchial reactivity to the day-to-day clinical expression of asthma is uncertain. We have examined this relationship in a longitudinal study of eight children and 12 adults. Measurements of reactivity to methacholine were made every 2 to 3 wk over a period of 12 to 18 months, deriving the dose that caused a 20% fall in FEV1 (PD20). Throughout the study, all patients kept a daily record of symptoms and treatment and twice daily measurements of peak expiratory flow (PEF). A significant relationship was found between subjects' overall reactivity (median PD20) and both their average day-to-day variation in morning PEF (Spearman's rho = -0.53, p = 0.016) and diurnal variation in PEF (Spearman's rho = -0.60, p = 0.004). However, examining the temporal relationship between reactivity and asthma within subjects, individual PD20 measurements were not consistently related to concurrent asthma severity: in only six subjects did changes in PD20 generally reflect simultaneous trends in symptoms or PEF. In several patients, exacerbations of asthma occurred in the absence of bronchial hyperreactivity (PD20 greater than 12.8 mumol). We conclude that nonspecific bronchial reactivity is only one mechanism underlying airflow obstruction in asthma, and that its relationship to the clinical state of asthma is not sufficiently close to be of practical clinical use.

Adolescent↗
PubMed1988

Energy, protein, zinc and copper status of twenty-one elderly inpatients: analysed dietary intake and biochemical indices.

1. Duplicate diet analysis for energy, protein, zinc and copper with estimates of biochemical status for Zn and Cu were undertaken in twenty-one elderly long-stay inpatients (mean age 82 (range 63-89) years) consuming their customary hospital diet and in a stable medical condition. Fourteen patients had a long-standing and significant healing problem, either a leg ulcer or pressure sore. 2. Mean daily intakes of energy (5.2 MJ), protein (45 g), Zn (85 mumol) and Cu (14 mumol) were low in comparison with both official recommendations and levels of intake at which metabolic equilibrium was observed in healthy elderly people studied by the same methods (Bunker et al. 1984a). 3. Mean leucocyte Zn (9 pmol/10(6) cells) and Cu (7.5 pmol/10(6) cells) were low in comparison with results from healthy elderly people (Bunker et al. 1984a), implying suboptimal status for these elements. Those patients with healing problems tended to have the lower values within the range. 4. Recommendations are made with respect to improving nutritional status in this disadvantaged group of people.

Aged↗
PubMed1988

British Diabetic Association holidays--what are they worth?

A postal survey among families of 63 children attending two BDA educational holidays studied their expectations before (Questionnaire 1) and experiences 3 months afterwards (Questionnaire 2). Of 47 families replying to both questionnaires (22M, 25F; mean age 8.4 years, range 5-13.8 years), expectations expressed by parents for their children were that they gain in confidence and independence (n = 36), mix with other diabetic children (n = 32), learn to self-inject (n = 27), improve diet (n = 23), and have a good holiday (n = 10). Thirty-five families subsequently reported that their expectations had been met. After the holiday, although there was no change in frequency of blood or urine testing, there was an increase in children doing tests on their own (Q1: 15, Q2: 28, p = 0.003); more parents reported confidence in their child recognizing a hypoglycaemic episode (Q1: 29, Q2: 39, p = 0.001); and there was a sustained increase in independence with insulin injections (Q1: 29, Q2: 35, p = 0.042). This study provides evidence that BDA holidays benefit parents and their children, and do so mainly by increasing the children's confidence and independence in diabetic care.

Anxiety, Separation↗
PubMed1988

The prevalence of proteinuria detected by Albustix in a defined diabetic population.

All the known diabetic patients (917) from a defined population (90,660) were called for review by a single observer. A total of 842 (92%) attended and proteinuria, identified using Albustix (0.3 g/l or more), was found in 57 cases (6.8%), but in 9 this was in association with a urinary tract infection. Diastolic blood pressure, an ulcerated or amputated lower limb, and smoking category were found to be the only significant predictors of proteinuria after a multiple logistic regression analysis. A serum creatinine greater than 150 mumol/l was found in 29 (3.8%) of the 768 diabetics in whom it was measured. However, proteinuria was only present in 7 of the diabetics with impaired renal function. In those aged less than 65 years, the prevalence of proteinuria with impaired renal function was 0.75%.

Age Factors↗