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Biomedical subjects

M D Warren

Publications and source records attributed to M D Warren.

At least 19 recordsLinked to original sources
PubMed1991

Correlation of in-vitro parameters of antimicrobial activity with prophylactic efficacy in an intradermal model of Staphylococcus aureus infection.

Cephalosporins differ in their ability to prevent staphylococcal wound infection. Although the reasons for the observed differences are not fully understood, the susceptibility of cephalosporins to hydrolysis by staphylococcal beta-lactamase has been correlated with failures of prophylaxis. To investigate the effect of beta-lactamase stability and other in-vitro parameters of the bacterial-antimicrobial interaction on the efficacy of antimicrobial prophylaxis, two beta-lactamase-stable agents, cefuroxime and cefmetazole were compared to cefazolin and cefamandole in an in-vivo model of intradermal infection employing four strains of Staphylococcus aureus. Following intraperitoneal administration of a single dose of cephalosporin or placebo, guinea pigs were inoculated at multiple intradermal sites with 2 x 10(7) cfu of a strain of staphylococcus. For three strains, the area of induration at 24 h following inoculation was significantly smaller in guinea pigs receiving prophylaxis with cephalosporins versus placebo; no cephalosporin was effective against the fourth strain. Differences were also noted among the cephalosporins; prophylaxis with cefuroxime and cefmetazole resulted in smaller lesions than seen in animals given cefazolin or cefamandole. Poor correlation was noted between results of the in-vivo model and in-vitro determinants of the bacterial-antimicrobial interaction which were MIC values, time-kill curves, and the rates of beta-lactamase-mediated cephalosporin hydrolysis by the different strains. The model demonstrated unexplained failures of prophylaxis and unexpected differences in efficacy of various cephalosporins as has been described before. This study highlights the need for an improved animal model of surgical antimicrobial prophylaxis and the identification of in-vitro determinants that predict in-vivo prophylactic efficacy more accurately.

Animals↗
PubMed1985

The Canterbury studies of disablement in the community: prevalence, needs and attitudes.

The Health Services Research Unit at the University of Kent at Canterbury was set up in 1971, with financial support from the Central Government's Department of Health and Social Security. One area of major concern has been the study of the number and needs of disabled people living at home and of services provided to meet those needs. In a City-wide survey of the whole population, it was found that about 5 per cent of the people living at home had significant impairments, about half of whom had or required some support. Registers of disabled people and records of services helping them were found to be an inadequate source of data for estimating total numbers and needs. A separate study validated the broad clinical information given by the respondents. The original population of impaired people were revisited years after the first survey. 13 per cent had died, mortality being highest among those with the severer degrees of dependency; 25 per cent had had at least one episode of serious illness; and 61 per cent reported more difficulties overall than they had in the initial survey. Although 75 per cent of the needs expressed in the initial survey had been met or ameliorated. Other studies have examined means of detecting visual disability, the value of domiciliary physiotherapy, and occupational therapy and the need for special dental services for some disabled people. Inevitably some biases are introduced into the design of population-wide surveys of disabled people. Important among these are the definitions used of 'impairment', 'disability' and 'handicap'; the orientation of the questions asked (which tend define 'need' in terms of the perceptions of the provider of services rather than of the disabled person); and, in the measures used to quantify the data collected. Further areas of research needed are discussed at the end of the paper.

Adolescent↗
PubMed1976

Medical records in family practice. A review.

The organisation of general practice in England is outlined and the independent contractor basis of the family practioner emphasised. Data from family practice, like data from hospital practice, may be used for clinical management, practice management, or research. Examples of applications in each of these fields are given. The basic records used in family practice--the medical record envelope, the prescription form and the claim for sickness benefit--are described. Some practices record morbidity (E Book or Diagnostic Index), some record systematically details of their activities (L Book or Activities Ledger) and some maintain age and sex registers and other registers of their patients; all these developments are outlined. Attention is drawn to the introduction of problem orientated records and to the use of computers in family practice, but these innovations are not discussed. Outstanding issues are the same as those in hospital record systems--accuracy, definitions, coverage, confidentiality, clerical support and costs, and the use made of the information.

Confidentiality↗
PubMed1976

Identifying handicapped people in general practice.

This study used the age-sex register of a group medical practice as the population base for a postal and follow-up interview enquiry to locate handicapped people and examined the possibility of the combined use of a practice diagnostic index and the patients' medical records for the same purpose. The age-sex register was found to contain deficiencies and inaccuracies despite the substantial efforts of members of the practice team to maintain it, for example, 13.5 per cent of the forms were returned as the addressee was unknown at the address.The 81.5 per cent of householders who responded identified 353 impaired people who were subsequently interviewed about the nature of their impairment, the underlying condition, and the range of their activities. Depending upon the answers to these questions, a proportion of these people were classified as handicapped and were asked further questions. The number of impaired people and their distribution in sex and age-groups were broadly similar to the findings from other surveys. The diagnoses of the underlying conditions given by the impaired people were discussed with the general practitioners and confirmed or otherwise by the use of the patients' notes or the recollections of the general practitioners.It was concluded that while the use of a diagnostic index would be helpful for some conditions, there would remain a substantial number of people with a disease that is potentially disabling who would have to be approached for further screening and also a substantial number of people who are handicapped, but who would be missed.

Persons with Disabilities↗
PubMed1972

Rehabilitation.

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Humans↗
PubMed1972

The unity of medicine.

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Communicable Disease Control↗