Strengthening the NIDR-university relationship.
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Biomedical subjects
Publications and source records attributed to P Sheridan.
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OBJECTIVE: To study patients' perceptions of why they consulted the doctor, how ill they thought they were, and what happened in the consultation. To compare patients' perceptions before and after the consultation and to compare these perceptions with those of the doctor. DESIGN: Patients filled in a questionnaire before and after the consultation. The doctor filled a questionnaire in after the consultation. SETTING: Three general practices in Bedfordshire and one in Hertfordshire. PATIENTS: 500 consecutive patients consulting in each practice. MAIN OUTCOME MEASURES: Changes in patients' perceptions and differences between the perceptions of patients and doctors. RESULTS: Doctors perceived patients to be less ill than the patients themselves did. Patients from social classes IV and V and children perceived themselves to be more ill than the average. Patients perceived themselves to be less ill after the consultation. A third of patients attended because doctors had told them to, and a quarter of patients had already tried to treat their problem themselves when they attended the consultation. Doctors' perceptions of the consultation emphasised listening, supporting, and giving advice. Patients' perceptions emphasised prescribing, reassuring, and referring to a consultant. Doctors perceived that they listened, examined, and gave advice less to social classes IV and V than to social classes I, II, and III and gave explanations more often to men than to women. Patients perceived external factors rather than lifestyle factors as being more important in causing their problems. CONCLUSION: Doctors' perceptions of patients' problems differed from those of patients expressed both before and after their consultation. Doctors' and patients' perceptions also differed about the consultation itself. The consultation reassured some patients.
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Because the incidence of thyroid disorder is much greater than expected in chronic active hepatitis we have evaluated routine in vivo and in vitro tests of thyroid function in forty one clinically euthryoid patients with chronic active hepatitis and in five patients with chronic active hepatitis and concomitant or previous clinical thyroid disease. Serum thyroxine, thyroid hormone binding, triiodothyronine, thyrotrophin releasing hormone tests and thyroidal uptake of radio-iodine all gave misleading information in some clinically euthyroid patients with chronic active hepatitis. However, the free thyroxine index calculated from the serum thyroxine and thyroid hormone binding level gave results that accorded with the clinical impression in all but two of the euthyroid patients whose results were borderline and subsequently normal and in all but one of those with past or current thyroid disorder. This suggests that anomalies of protein binding accounted for abnormal results in thyroxine and thyroid hormone binding levels.
Four patients with hyperparathyroidism who presented in atypical or uncommon ways to a general medical unit are described. The unusual features are discussed and the value of modern procedures for localization of a parathyroid tumour is confirmed.
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The increase in plasma-fluorogenic-corticosteroids in response to a single injection of tetracosactrin depot was measured in eleven patients with suspected acute renal insufficiency who were treated simultaneously with prednisolone and deoxycorticosterone acetate (D.O.C.A.). Acute adrenal insufficiency was excluded in seven patients within 24 hours. There was no response in the remaining four patients, and prolonged corticotrophin stimulation tests confirmed the diagnosis of Addison's disease.
3H-corticoids were localized by autoradiography in small neurons in the area of the magnocellular paraventricular nucleus of mallard ducks. Correlative data show that: (1) the label is principally unmetabolized steroid, (2) the hypothalamus competitively binds corticosterone, (3) the paraventricular nucleus contains immunoreactive neurophysin, is richly innervated by boutons of monoaminergic nerves and is involved in the adaptive response to osmotic stress.