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Biomedical subjects

P R Elliott

Publications and source records attributed to P R Elliott.

At least 37 records · Page 2Linked to original sources

Colonoscopy in a private hospital: continuous quality improvement in practice.

This paper documents serial audits on technical aspects of the performance of fibre-optic examination of the large intestine by a number of proceduralists, in one institution, over 7 years. The completeness of the procedure and the associated morbidity are recorded and compared with results reported in the world literature. The study provides a clear demonstration of continuous quality improvement in practice.

Clinical Competence↗

Handwashing: a process of judgement and effective decision-making.

It is well-known that regular handwashing is an effective way of reducing cross-infection. Healthcare professionals need to be encouraged to evaluate their practice in the light of research-based evidence of their patients' needs, so improvements can be made.

Cross Infection↗

Relationship of scholarships and indebtedness to medical students' career plans.

Discriminant functions analyses of data from the 1983 survey of senior medical students by the Association of American Medical Colleges showed that the effects of scholarships must be taken into account when assessing the influence of indebtedness on medical students' career choices. Receipt of a federal scholarship, type of medical school attended (public or private), marital status, sex, and receipt of a nonfederal scholarship were found to be more powerful than indebtedness as predictors of whether the students preferred primary care or nonprimary care specialties. Receipt of a federal scholarship, type of school attended, and sex were found to be more powerful than indebtedness as predictors of whether the students preferred private clinical practice, salaried clinical practice in a hospital or clinic, salaried clinical practice in a public agency, or a nonclinical career. Indebtedness was found not to be a predictor of willingness to locate in a socioeconomically deprived area.

Career Choice↗

The microbial flora of the rectal mucosa and faeces of patients with Crohn's disease before and during antimicrobial chemotherapy.

The faecal flora and mucosa-associated flora (MAF) of rectal biopsy material from 12 patients with active Crohn's disease were studied before and during treatment with a combination of metronidazole and cotrimoxazole given orally for at least 2 weeks. The total faecal flora was greater than the MAF although the proportions of bacterial groups were similar. The changes observed during treatment were: obligate anaerobes such as Bacteroides spp. decreased in faeces (p less than 0.05) and in MAF (p less than 0.02); the total count of facultative bacteria increased in the faeces (p less than 0.002) but not in the MAF. Streptococci, predominantly enterococci, increased significantly in faeces (p less than 0.001) and in MAF (p less than 0.02) such that they became predominant components of these florae. Facultative gram-negative bacilli were unaltered in faeces but significantly reduced in the MAF (p less than 0.05). Sporing clostridia were infrequently isolated from the MAF but were significantly reduced in the faeces (p less than 0.01). During the treatment period, eight of the 12 patients showed clinical improvement, but this could not be related to the site or extent of disease or to specific changes in faecal flora or MAF. This combination of antibacterial agents causes profound alterations to the bacterial flora of mucosa and faeces and these changes may help to define the role of bacteria in the pathogenesis of Crohn's disease.

Adult↗

Colonoscopic diagnosis of minimal change colitis in patients with a normal sigmoidoscopy and normal air-contrast barium enema.

8 patients with normal sigmoidoscopic appearances and normal results by high-quality air contrast barium enema had substantial or total colitis diagnosed for the first time at colonoscopy performed within a month of the radiological examination. Colitis was confirmed in all 8 patients by histological examination of biopsy specimens. Barium enema radiographs were independently reviewed by three experienced observers who also reviewed other normal and abnormal radiographs. One observer regarded all 8 sets of radiographs from the patients with colitis as being of normal appearance, and 4 patients were reported as having normal radiographs by all three observers. All 7 of the rectal biopsy specimens taken showed histological features of inflammatory bowel disease. This emphasises the importance of performing a rectal biopsy in patients with gastrointestinal symptoms of unknown cause.

Adult↗

Plasma prednisolone levels during intravenous therapy in acute colitis.

Maximum plasma levels in six acute colitics were about three times greater after an intravenous bolus of 20 mg prednisolone than the mean level achieved during infusion of the same dose (p<0.001) over eight hours; the level during infusion was about twice as great as the maximum recorded previously after a single 40 mg oral dose of prednisolone. These findings favour the use of intravenous administration in severe acute colitis. No difference was found between plasma levels of patients and six normal subjects after the intravenous bolus.

Acute Disease↗

Chlamydiae and inflammatory bowel disease.

No association was found between inflammatory bowel disease and infection with C. trachomatis or C. psittaci when patients were tested for the presence of these organisms using immunohistological, cell culture isolation, and serological techniques.

Adult↗

Prednisolone absorption in acute colitis.

Peak plasma levels were reduced after an oral dose of 40 mg prednisolone in six patients with severe acute colitis as compared with six normal subjects, though total absorption appeared to be similar; the findings suggest that prednisolone absorption was delayed in acute colitis. A dilutional fall in plasma albumin was observed in normal subjects and in the patients after 40 mg prednisolone by mouth.

Acute Disease↗

Comparison of exercise responses of males and females during acute exposure to hypobaria.

Seventeen male and 20 female college students were tested on a bicycle ergometer in a hypobaric chamber to determine whether both sexes had similar submax and max exercise responses to acute hypoxia. Initial testing was at a terrestrial altitude of 1576 m, to which the subjects were acclimated; subsequent tests were at simulated altitudes of 2743 m and 3962 m. Analysis of covariance showed that inspired V was the only variable during submaximal work (50% max) to exhibit a significant difference in altitude response between males and females; women had a smaller increase than men. During max work, V and O2 pulse increased less in women. At 2743 m, max VO2 decreased more in females whereas, at 3962 m, no difference was noted. It was concluded that during both submaximal and maximal work with acute altitude exposure, women would demonstrate smaller relative increases in ventilation than would men.

Adolescent↗