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Biomedical subjects

P McDonald

Publications and source records attributed to P McDonald.

At least 19 recordsLinked to original sources
PubMed1992

Health promotion in the general practice consultation: a minute makes a difference.

OBJECTIVE: To see whether extending appointment length from seven and a half minutes or less to 10 minutes per patient would increase health promotion in general practice consultations. DESIGN: Controlled trial of 10 minute appointments. Consultations were compared with control surgeries in which the same doctors booked patients at their normal rate (median six minutes per patient). SETTING: 10 general practices in Nottinghamshire. SUBJECTS: 16 general practitioners were recruited. Entry criteria were a booking rate of eight or more patients an hour, a wish for longer consultations, and plans to increase appointment length. MAIN OUTCOME MEASURES: Duration of consultations; recording of blood pressure, weight, and cervical cytology in the medical record; recording of advice about smoking, alcohol, diet, exercise, and immunisation in the medical record; reporting of the above activities by patients. RESULTS: Mean consultation times were 8.25 minutes in the experimental sessions and 7.04 and 7.16 minutes in the control sessions. Recording of blood pressure, smoking, alcohol consumption, and advice about immunisation was significantly more frequent in the experimental sessions, and the proportion of consultations in which one or more items of health education were recorded in the medical notes increased by an average of over 6% in these sessions. Patients more often reported discussion of smoking and alcohol consumption and coverage of previous health problems in the experimental sessions. There was little change in discussion of exercise, diet, and weight or cervical cytology activity. CONCLUSIONS: Shortage of time is a major factor in general practitioners' failure to realise their potential in health promotion. General practice should be organised so that doctors can run 10 minute appointment sessions.

Adult↗
PubMed1992

Plain film and CT observations in prostaglandin-induced bone changes.

Prostaglandin E1 intravenous infusion is used in infants with ductal-dependent congenital heart disease to maintain ductal patency and prolong life until palliative or corrective surgery is feasible. Complications of prostaglandin administration include fever, diarrhoea, hypotension, apnoea, bradycardia, pseudowidening of the cranial sutures, underossification of the calvarial bones, periostitis, and skin edema [1-3]. This paper presents dramatic plain radiographic features of prostaglandin-induced bone disease, including periosteal proliferation and the unusual bone-within-bone appearance, and provides the previously unpublished CT correlation.

Alprostadil↗
PubMed1992

Evaluation of renal scars by technetium-labeled dimercaptosuccinic acid scan, intravenous urography, and ultrasonography: a comparative study.

The objective of our prospective study was to compare the sensitivity and specificity of ultrasonography, intravenous pyelography, and dimercaptosuccinic acid scan in detecting scarred kidneys. Twenty-seven consecutive subjects with recurrent urinary tract infections, vesicoureteral reflux, scarred kidneys, or a combination of these problems had all three imaging procedures performed. With the total number of scars serving as the gold standard, the sensitivity (94%) and specificity (100%) in identifying renal scars in children were highest for the DMSA scan. Intraobserver (95%) and interobserver (90%) reliability were also high for the DMSA scan. However, the clinical interpretation of the increased sensitivity of the DMSA scan is unknown. Changes on the scan not identified by intravenous urography may not represent true scars. Research into the long-term significance of these scars is indicated.

Adolescent↗
PubMed1992

Oral health and oral health behaviour in a population of diabetic outpatient clinic attenders.

The control of oral health in individuals suffering from diabetes mellitus may affect a diabetic individual's insulin requirements. This study examined the oral health status and behaviours of a group of diabetic patients and compared the results to those obtained in a recent UK national survey of oral health. The results showed that, despite reporting higher levels of oral self-care, the diabetic population suffered from higher rates of caries than "normal" individuals. These differences could not be accounted for by the treatment received from dentists. It is concluded that diabetic patients are more caries prone than the general population and that the cause of this difference should be sought, as the traditional aetiological agent for caries cannot account for the increased caries rate. If the aetiology of the findings of this study were determined, progress could be made in the search for indicators of increased caries risk.

Adolescent↗
PubMed1992

Stereotactic localization and guidance using a machine vision technique.

Machine vision techniques (video cameras) can be used to determine the three-dimensional position of objects. This transformation can be accomplished with standard mathematical algorithms. Initial accuracy tests of stereotactic localization with video cameras were performed using a standard Brown-Roberts-Wells (BRW) phantom simulator coupled with the BRW angiographic localizer. Localization accuracy was within 1.5 mm. Potential applications of machine vision techniques include freehand stereotactic localization of the position and orientation of surgical instruments. With sufficient computer speed these techniques can be used for continuous monitoring of the position of instruments within the cranial vault.

Brain↗
PubMed1992

Residents of private nursing homes and their care.

A study was undertaken to examine the characteristics of residents in private nursing homes, to measure residents' dependency levels, to determine the adequacy of procedures for admitting new residents and to explore general practitioners' work with residents. Details were obtained of 61 nursing homes registered by Nottingham district health authority and of a selection of residents. Information about residents provided by the nurses in charge included aspects of self care, orientation and social integration, these items contributing to a dependency score for each resident. General practitioners completed postal questionnaires. Information was sought on the numbers of residents on the general practitioners' lists, visiting patterns, and opinions on their work with residents. It was found that almost half of the reports accompanying residents on admission were considered inadequate by the nurses in charge. The 357 residents varied widely in dependency level, need for nursing care and medication; 31% had low dependency scores. Most of the residents (57%), had been admitted from hospital, 26% from their own home and 15% from other nursing or residential homes. Higher overall dependency levels, problems with mobility and continence and need for care of wounds, catheters or colostomies were more frequent in residents admitted from hospital or nursing or residential homes than in those admitted from their own home. The 70 responding general practitioners varied widely in the numbers of residents on their lists and in their visiting patterns. The 16 general practitioners providing medical care for entire nursing homes were significantly more likely than the other general practitioners to visit routinely.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Aneurysmal bone cyst of the upper thoracic spine. An operative approach through a manubrial sternotomy.

Surgical access to T-1 and T-2 vertebral bodies through standard cervical approaches may be difficult and extensive in patients with short necks or high sterna. Adequate exposure of this area can be achieved in children, using a partial manubrial sternotomy and retraction of the manubrial halves. This procedure was successfully performed in a 14-year-old girl whose T-1 vertebra had been completely replaced by a large aneurysmal bone cyst that had produced major paraparesis. A two-stage anteroposterior excision and spinal fusion resulted in complete restoration of neurologic function, eradication of the cyst, and stabilization of the cervicothoracic spine. The limited manubrial split approach to lesions in the T-1 and T-2 vertebrae is recommended.

Adolescent↗
PubMed1991

Protein phosphatase 2Bw and protein phosphatase Z are Saccharomyces cerevisiae enzymes.

cDNAs encoding three protein phosphatases, termed PP2Bw (Da Cruz e Silva, E.F. and Cohen, P.T.W. (1989) Biochim. Biophys. Acta 1009, 293-296), PPZ1 and PPZ2 that have been isolated from a Clontech 'rabbit brain' library are shown to be Saccharomyces cerevisiae clones. PPZ1 and PPZ2 are two novel yeast phosphatases showing 93% amino acid sequence identity to one another. PPZ1 shows approx. 60% sequence identity to S. cerevisiae or mammalian PP1 and approx. 40% identity to S. cerevisiae or mammalian PP2A. These and other observations suggest that the two isoforms of PPZ have functions distinct from those of PP1.

Amino Acid Sequence↗
PubMed1991

Longer booking intervals in general practice: effects on doctors' stress and arousal.

A controlled trial was carried out to determine whether longer booking intervals at surgeries affected general practitioners' self-assessed levels of stress and arousal. Sixteen general practitioners from 10 practices took part. Surgery sessions with patients booked at 10 minute intervals (experimental sessions) were compared with the doctors' usual booking intervals of between 7.5 and 5.0 minutes (control sessions). Stress and arousal were assessed by the general practitioner before and after each surgery session using a mood adjective check list. The study included 109 experimental and 184 control sessions. The median consultation length increased from six minutes in the control sessions to seven minutes in the experimental sessions. At the end of the experimental sessions, stress scores were lower, and arousal scores higher than at the end of the control sessions (P less than 0.001). There were no significant differences between experimental and control sessions in stress or arousal at the start of the sessions. Favourable mood changes were seen more consistently in the experimental sessions than control sessions, with less than a quarter of doctors showing increased stress or decreased arousal after sessions relative to before. It is concluded that longer booking intervals are of psychological advantage to general practitioners.

Adult↗
PubMed1991

An aqueous paracentesis pipet.

We describe a glass pipet tipped with a short, sharp, 30-gauge needle for performing aqueous paracentesis. The design eliminates the possibility of needle bending and minimizes fractional resistance during limbus penetration; it also allows quicker recovery of aqueous samples. A small plastic bulb at the upper end facilitates removal of aqueous samples from the pipet.

Aqueous Humor↗
PubMed1990

A century of home parenteral nutrition for Crohn's disease.

During an 11-year period, 41 patients with Crohn's disease were placed on home parenteral nutrition (HPN) for a mean of 1,083 days (range: 33 to 3,258 days). Data were retrospectively analyzed to determine whether HPN had an effect on the course of their disease, i.e., on the number of operative procedures performed and the intensity of required medical therapy. Data represented information obtained during a total of 121 patient-years of HPN for Crohn's disease. The main indications for HPN were short bowel syndrome (66%) and high stoma output. Twenty-four of 41 patients (59%) underwent surgery for Crohn's disease during the course of HPN. There was no significant difference between the number of procedures performed per patient per year of Crohn's disease during pre-HPN and HPN periods (p greater than 0.25). Although there was no significant change in body weight, both serum albumin and transferrin levels increased during HPN (p less than 0.01 and p less than 0.01, respectively). Twenty-nine percent of patients were taking prednisone while on HPN, compared with 54% of patients during the pre-HPN period (p less than 0.01). HPN appeared to result in a significant improvement in the numerically assessed quality of life. During the HPN period, 24 patients had 1 or more HPN-related complications that required 1 to 13 hospital admissions (mean: 1.8). These complications included catheter sepsis in 19 patients, blocked or damaged catheters in 15 patients, and dehydration and/or electrolyte imbalance in 5 patients. Eight patients died, with 7% of deaths secondary to catheter-related sepsis. Although permanent HPN is associated with an identifiable morbidity and mortality and is not associated with a reduction in the frequency of surgery for Crohn's disease, benefits include a decrease in the intensity of medical therapy, an improvement in patients' nutritional state, and a significant perceived improvement in patients' quality of life. Without HPN, we believe all patients would have died secondary to malnutrition and/or dehydration.

Adult↗
PubMed1990

Simvastatin in the treatment of hypercholesterolaemia in patients with essential hypertension.

Mortality from coronary artery disease is a common problem in treated hypertensive patients, and these people have a high prevalence of elevated cholesterol levels. A study was undertaken to determine whether cholesterol could be lowered effectively without major side effects in patients with treated hypertension. Forty-nine patients (mean age 67.6 years) with cholesterol greater than 5.5 mmol/l were placed on a reduced-fat (less than 30% of calories from fat with a ratio of polyunsaturated to saturated fats of less than 1) diet for 3 months. If the cholesterol was between 5.5 and 7.5 mmol/l and total cholesterol divided by high-density lipoprotein cholesterol was greater than 4.5, the patients were randomly allocated either to the simvastatin (24 patients) or the placebo group (25 patients). Diet and placebo caused minor and insignificant falls in cholesterol and no change in triglycerides or lipids. Treatment with simvastatin reduced cholesterol levels from 6.85 to 4.75 mmol/l (P less than 0.001), triglycerides from 2.7 to 2.1 mmol/l (P less than 0.01), low-density lipoproteins from 4.6 to 2.6 mmol/l (P less than 0.001) and high-density lipoproteins rose from 1.09 to 1.18 mmol/l (P less than 0.01). Total cholesterol divided by high-density lipoprotein cholesterol fell from 6.3 to 4.0 (P less than 0.001). The drug was well tolerated and the side-effect profile did not differ from the placebo in clinical or biochemical events. The active drug was stopped in one patient (abdominal pain, dizziness, headache, tiredness) and in two patients taking the placebo (elevated creatine phosphokinase, cardiovascular collapse). Simvastatin effectively lowered total cholesterol and improved the lipoprotein profile. The dose required in most patients was 40 mg/day. Simvastatin may be an acceptable drug to improve the lipoprotein profile in order to determine whether this improves the prognosis in patients treated for hypertension.

Adult↗
PubMed1989

Single-dose antibiotic prophylaxis in contaminated abdominal surgery.

Although perioperative antibiotic cover reduces the incidence of septic complications associated with abdominal surgery, the optimum duration of antibiotic exposure is open to question. This clinical trial compared the efficacy of a single dose of moxalactam (1 g intravenously) with an extended course of moxalactam (1 g intravenously for eight doses) in 1027 patients undergoing contaminated abdominal surgery. The wound infection rate was 5.4% (28/519) for the single-dose schedule and 6.1% (31/508) for the extended-cover regimen (the respective 95% confidence intervals being 3.6% to 7.7% and 4.2% to 8.6%). Over 80% of all patients undergoing abdominal surgery during the period of study were entered into the trial. There was no significant difference in the incidence of other complications between the two groups under study. It is concluded that a single dose of moxalactam is as effective as a 48-hour course when attempting to prevent infection after contaminated abdominal surgery.

Biliary Tract Surgical Procedures↗
PubMed1989

Hurricane Elena and Pinellas County, Florida: some lessons learned from the largest evacuation of nursing home patients in history.

Prior planning for and problems associated with the evacuation of 1,860 nursing home patients in Pinellas County, Florida, due to Hurricane Elena in 1985 were studied through questionnaires administered to nursing home administrators and public documents. The most serious problems were transporting patients to shelters in a timely fashion, delayed passage of recalled staff through police checkpoints, and staff burnout.

Aged↗