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Biomedical subjects

P McEvoy

Publications and source records attributed to P McEvoy.

At least 19 recordsLinked to original sources
PubMed2000

Gatekeeping access to services at the primary/secondary care interface.

This paper examines the role that mental health clinicians play in gatekeeping access to services at the primary/secondary care interface. Layder's research map is used to explore the factors that influence gatekeeping decisions at four interrelated levels of social organization; self, situated activity, setting and context, plus a historical dimension that permeates each level. The main theme that emerges from the analysis is that the dilemmas that arise from attempting to control the demand for care are difficult to resolve for policy makers, managers or clinicians alike. A combination of factors make it difficult to establish consistent priorities including: the uneven distribution of specialist services, the lack of a consensus definition of severe mental illness and the difficulty of weighing the potential benefits of care for the individual against the need to ensure that resources are distributed fairly. It is suggested that there are no easy answers to these dilemmas because gatekeeping is a socially contested process, in which there will be winners and losers.

Community Mental Health Services↗
PubMed2000

The pathology of diphtheria.

Diphtheria is an acute, communicable disease caused by Corynebacterium diphtheriae. The disease is generally characterized by local growth of the bacterium in the pharynx with pseudomembrane formation or, less commonly, in the stomach or lungs; systemic dissemination of toxin then invokes lesions in distant organs. Acute disease of the upper respiratory tract usually involves one or more of the following: tonsillar zones, larynx, soft palate, uvula, and nasal cavities. A recent epidemic in Russia emphasized the role of vaccination in reducing disease in children and adults.

Adult↗
PubMed1999

Mental health. Drawing the line.

Employing community psychiatric nurses to assess clients referred to community psychiatric teams can help target resources. The assessment nurses deal both with routine and emergency referrals. Some GPs were initially concerned about nurses undertaking assessments previously carried out by psychiatrists.

Community Health Nursing↗
PubMed1999

Mycobacterial spindle cell pseudotumor of the brain: a case report and review of the literature.

Spindle cell pseudotumors found in the skin, lymph nodes, bone marrow, spleen, lungs, and retroperitoneum have been reported recently in immunosuppressed patients, including those with acquired immunodeficiency syndrome. The authors report a similar lesion limited to the brain in a 38-year-old human immunodeficiency virus-negative man receiving steroid therapy for treatment of sarcoidosis. Histopathologically the lesions were composed of spindle and epithelioid histiocytes, small foci of necrosis, and numerous acid-fast bacilli. The acid-fast bacilli were determined by culture and polymerase chain reaction to be Mycobacterium avium intracellulare. Because of the uncommon histologic appearance of this lesion and the potential for treatment if recognized, mycobacterial spindle cell pseudotumors should be included in the differential diagnosis of spindle cell lesions in the brain in immunosuppressed patients.

Adult↗
PubMed1998

Psychiatry at the front line: CPNs working outside regular hours in an inner-city A&E department.

This paper reports on a study that examines the characteristics of patients with mental health problems, seen outside regular working hours, by CPNs working within an in an inner-city A&E department. The study examined the range of presenting problems for each individual attendance rather than the primary diagnosis or main presenting problem. There were significant differences in the pattern of presentations between patients with and without a mental health professional (MHP) involved in their care. Patients with a MHP involved in their care were much more likely to present with psychosis and suicidal ideation in the absence of deliberate self-harm. Those without a MHP were much more likely to have deliberately harmed themselves, to have interpersonal problems, to have misused alcohol or drugs or to have work/financial problems. The CPNs worked in an autonomous manner and appeared to reduce the intensity of the duty psychiatrists' workload by filtering out patients judged not to be in need of their specialist input.

Adult↗
PubMed1998

Leishmaniasis in the United States military.

Leishmaniasis is a recurrent health problem for the U.S. and other militaries. Health care workers may be unfamiliar with the risk factors, transmission, clinical features, diagnosis, and treatment of this disease. A team of highly trained specialists is required to properly manage service members with leishmaniasis. Such care is available only in a few medical centers. Although there are no prophylactic drugs to prevent this disease, control of insect populations and use of personal protection measures can minimize arthropod-related casualties. The impact of leishmaniasis on military operations and research initiatives to better prevent, diagnose, and treat infection are discussed.

Humans↗
PubMed1997

Treatment of Nocardia asteroides keratitis with polyhexamethylene biguanide.

PURPOSE: Polyhexamethylene biguanide (PHMB) is a polymeric biguanide disinfectant that has been used previously in the treatment of Acanthamoeba keratitis. The authors report the first case of Nocardia asteroides keratitis treated successfully with PHMB. Further studies documenting the efficacy of PHMB against N. asteroides in vitro also are presented. METHODS: A soft contact lens wearer presented with an infectious keratitis. Cultures from the cornea grew N. asteroides. The infection resolved with the treatment with PHMB 0.02%. Serial dilutions of PHMB were performed against N. asteroides in culture. RESULTS: In vitro dilution studies determined that the minimal inhibitory concentration for PHMB against the tested isolate of N. asteroides was 0.01%. This is a concentration that has been shown to be well tolerated by the cornea in vivo. CONCLUSIONS: Polyhexamethylene biguanide is effective against both Acanthamoeba and Nocardia and may have a wider range of usefulness than that currently recognized. Further testing, both in vitro and in vivo, is required.

Adolescent↗
PubMed1992

Transcription patterns of human papillomavirus type 16 in genital intraepithelial neoplasia: evidence for promoter usage within the E7 open reading frame during epithelial differentiation.

Human papillomavirus (HPV) type 16 transcription was analysed by in situ hybridization using 125I-labelled subgenomic riboprobes, from 26 genital intraepithelial neoplastic (IN) lesions, in formalin-fixed biopsies from 18 different cases. Distinct transcription patterns separable by the presence or absence of late gene transcription were detected. In 12 lesions, late gene expression was absent; HPV transcripts corresponding to the E6 and E7 open reading frame (ORF) were detectable in all basal cells and were usually evenly distributed through all layers of the epithelium. Transcripts corresponding to the E1, E2 and E2/E4 ORFs were present in nine of 12 lesions and displayed a similar distribution. In 14 lesions late gene transcripts were present. E6 and E7 transcripts were detectable basally in all but one lesion. The levels of E7 but not E6 transcripts were markedly increased in the superficial cells of differentiating epithelia, with an identical distribution and at similar levels to those of the E2/E4 transcript. We propose that the most abundant transcript in genital IN lesions containing late gene expression is an E7/E1 [symbol: see text] E2/E4 transcript corresponding to that reported in HPV-6/11 condylomata and which is derived from a similar promoter within the E7 ORF.

Cell Transformation, Neoplastic↗
PubMed1990

Inhibition of lymphocyte IL2-receptor expression by factor VIII concentrate: a possible cause of immunosuppression in haemophiliacs.

Factor VIII concentrate inhibits T-cell function in vitro and in vivo. The mechanisms underlying the phenomenon were investigated. Factor VIII concentrate has a direct effect on lymphocytes, uninfluenced by haemophilic monocyte dysfunction, since it inhibited lymphocyte transformation with phorbol myristate acetate, a reaction unaffected by monocyte depletion. Inhibition of lymphocyte transformation by factor VIII concentrate is not corrected by the addition of exogenous IL2, suggesting that it does not inhibit lymphocyte function by suppression of IL2 secretion alone. Factor VIII concentrate causes profound inhibition of IL2-receptor expression (CD25); with an 89% reduction in CD25-positive CD4 cells and a 50% reduction in CD25-antigen molecules per cell. CD8 lymphocytes are similarly affected. Smaller reductions in CD71 and HLA-DR expression are also observed. Down modulation of CD25-antigen may explain the reduced IL2 secretion observed by others, and may be an important cause of immunodeficiency in HIV-seronegative haemophiliacs.

Antigens, CD↗