Biomedical subjects
M Clapham
Publications and source records attributed to M Clapham.
South Birmingham Coronary Prevention Project: a district approach to the prevention of heart disease.
The South Birmingham Coronary Prevention Project is described, in which health checks by practice nurses in GPs' surgeries are combined with direct patient access to a secondary referral system. Where appropriate, health check attenders are offered the choice of either (a) counselling by the practice nurse, (b) direct referral to their GP, or (c) direct referral to secondary intervention, including specialist dietary advice for patients with high (greater than 6.5 mmol/l) serum cholesterol, stress management training for mild hypertension (diastolic blood pressure greater than 90 less than 105 mmHg), and smoking cessation groups. Significant reductions in blood pressure (p less than 0.005) and serum cholesterol levels (p less than 0.001) have been achieved. Further, substantial numbers of smokers have ceased since attending smoking cessation groups. This multidisciplinary approach to the identification and modification of risk factors for coronary heart disease may provide a powerful adjunct to wider ranging population interventions.
A multi-disciplinary approach to the prevention of coronary heart disease.
The South Birmingham Coronary Prevention Project is described, in which health checks by practice nurses in GPs' surgeries are combined with direct patient access to a secondary referral system. Where appropriate, health check attenders are offered the choice of either counselling by the practice nurse, direct referral to their GP, or direct referral to secondary intervention, including dietary advice for patients with high serum cholesterol, stress management training for mild hypertension, and smoking cessation groups run by specialist workers. Further developments of the project may be toward increasing areas of nurses intervention, for example running lipid clinics, and combining with Look After Your Heart! in the workplace. Progress in each of these areas is described and discussed.
Cocaine and adrenaline paste (reply)
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The effects of formulation and addition of adrenaline to cocaine for haemostasis in intranasal surgery.
Twenty patients presenting for submucous resection of the nasal septum under general anaesthesia were randomly allocated to four groups to receive either 1.0 ml 25% cocaine HCl in paraffin paste, 1.0 ml 25% cocaine HCl combined with 0.1% adrenaline in paraffin paste, 4.0 ml aqueous 4% cocaine HCl combined with 0.05% adrenaline or 4.0 ml aqueous 4% cocaine HCl on ribbon gauze applied to the nasal mucosa. Mean intraoperative blood loss was significantly decreased when the 25% cocaine 0.1% adrenaline combination in paraffin paste was used (11 (SD 8) ml, 60 (SD 30) ml, P less than 0.05, for adrenaline and plain paste respectively). Combination of adrenaline with cocaine in the aqueous formulation was not associated with a significant decrease in blood loss compared with aqueous cocaine alone (75 (SD 51), 96 (SD 66) ml respectively). Cocaine adrenaline paste and plain cocaine paste were associated with higher mean maximum cocaine blood concentrations (1.6 (SD 1.4), 2.0 (SD 1.5) micrograms/ml respectively) when compared with aqueous cocaine adrenaline and aqueous cocaine alone (0.03 (SD 0.003), 0.5 (SD 0.3) microgram/ml respectively). Heart rate and blood pressure changes were similar in all four groups and cardiovascular toxicity was not observed. One ml of topical intranasal 25% cocaine HCl with 0.1% adrenaline in paraffin paste provided the best haemostasis for nasal septal surgery.
The validity of oxygen content calculations.
Blood oxygen content calculated from haemoglobin concentration, measured haemoglobin oxygen saturation and measured oxygen tension was compared with three other methods of estimating oxygen content. These other methods were those of Van Slyke and Zander, which are direct methods, and a method using Kelman's equation to estimate the saturation from measured oxygen tension and hence content. The coefficients of correlation (corr coeff) (r) were 0.9050 (n = 22), 0.9919 (n = 24) and 0.9862 (n = 25) for the respective methods when compared with oxygen content calculated using measured saturation. The Van Slyke method proved to be imprecise in our hands. The direct measurement using the oxygen cuvette of Zander gave oxygen content values similar to those estimated from measured saturation. The oxygen content calculated from pO2 alone when compared to that derived from measured saturation had a corr coeff (r) of 0.9862 (n = 25), but the high residual standard deviation (So) of 6.939 ml/l indicates that the practice of calculating oxygen content from oxygen tension alone is imprecise. We conclude that oxygen content may be satisfactorily estimated by the Zander method when it becomes generally available, but until then the measurement of oxygen saturation is a necessary prerequisite to the estimation of blood oxygen content.
Transillumination for correct tube positioning: use of a new fiberoptic endotracheal tube.
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