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Biomedical subjects

P Townsend

Publications and source records attributed to P Townsend.

At least 37 records · Page 2Linked to original sources
PubMed1991

Bad news: delivery, dialogue, and dilemmas.

The narrative from a real patient encounter is used to illustrate the powerful effect that delivering bad news can have on both patient and physician. The meaning of bad news to the patient may be quite different than the medical or the personal meaning to the physician. Differences in perception must be explored and understood before the common ground necessary for joint decision making is established. Initial patient responses can be divided into three categories: (1) basic psychophysiologic (fight-flight or conservation-withdrawal), (2) cognitive, and (3) affective. Responses vary considerably depending on the meaning of the diagnosis to the patient, the degree of immediate threat, and the patient's previous experience with illness. Desired outcomes of the initial meeting include (1) minimizing aloneness and isolation for both patient and physician; (2) achieving a common perception of the problem; (3) giving information tailored to the immediate needs of the patient; (4) addressing immediate medical needs, including the risk of suicide; (5) responding to immediate discomforts; and (6) ensuring a basic plan for follow-up. Though all clinicians deliver bad news, few have had formal training or open exploration of the profound potential impact of the experience.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Free and total lidocaine levels in cardiac surgical patients.

A lidocaine bolus of 2 mg/kg has been shown to decrease the incidence of ventricular fibrillation in cardiac surgical patients during reperfusion following aortic cross-clamp release (CCR). In an effort to extend this effect into the immediate postoperative period, many centers routinely administer a prophylactic lidocaine infusion for the first 12 to 24 hours after surgery. Sequential total serum lidocaine levels were measured over 6 hours in 28 adult cardiac surgical patients without liver, kidney, or respiratory disease, and free serum lidocaine levels were measured in 15 of these patients. In addition, pharmacokinetic data were collected and analyzed in 8 of these patients. Each patient received a lidocaine bolus of 1.5 mg/kg and an infusion at 2 mg/min immediately before CCR. Serum levels were determined just before CCR, and at 10, 20, 30, 60, 120, 240, and 480 minutes after CCR. More than 50% of patients had subtherapeutic total serum lidocaine levels from 20 to 120 minutes after CCR, but free lidocaine levels remained within the therapeutic range. No patient showed malignant ventricular dysrhythmias during the study. The results suggest that (1) it may be misleading to estimate free lidocaine concentration based on total lidocaine levels; and (2) free drug is the moiety responsible for lidocaine's antiarrhythmic effect.

Adrenergic beta-Antagonists↗
PubMed1990

Individual or social responsibility for premature death? Current controversies in the British debate about health.

This article uses the current controversies in the British debate about health to illustrate the need to theorize, and therefore critically evaluate, the links between medicine and health policies, including health care policies. The medical model of health is deeply embedded in institutional practices in many countries, and while this model has attracted deserved criticism in recent years, an alternative social model, or one that incorporates indispensable aspects of the medical model, has attracted much less attention and requires sustained development. Comparative study of patterns of inequality in health, and especially of the correlation between material deprivation and premature mortality, necessarily reveals causal determinants of both health and ill-health in populations and invites ambitious programs to develop a social model.

Delivery of Health Care↗
PubMed1990

Widening inequalities of health in Britain: a rejoinder to Rudolph Klein.

Since the publication in 1980 of the Black Report, Inequalities in Health, critics have attempted to challenge its finding that for nearly all adult male and female age groups in Britain, inequalities in mortality between occupational class groups have widened during recent decades. This article seeks to refute one of the critics, using data published during the 1980s, and goes on to point out that if, as the Black Report also argued, material deprivation is the predominant scientific explanation for inequalities in mortality, then it is widening living standards between classes that we must examine to understand the trend.

Adult↗
PubMed1989

Leuprolide acetate in the treatment of refractory or persistent epithelial ovarian cancer.

Leuprolide acetate (Lupron, TAP Pharmaceuticals, North Chicago), a gonadotropin-releasing hormone analogue, was administered subcutaneously at a 1-mg dose for a minimum of 8 weeks to 23 patients with refractory epithelial ovarian cancer. Eighteen of these patients were evaluable. There were no complete responses. Four patients (17%) had a partial response, with a median duration of 52 weeks. Three of six patients with grade 1 carcinomas had a partial response and two had stabilized disease. There was only one response among 15 patients with grade 2 or 3 disease. Therapy was well tolerated, with three patients complaining of hot flashes and two of mild pedal edema. Leuprolide acetate thus shows evidence of antitumor activity against refractory grade 1 epithelial adenocarcinoma of the ovary. Further trials with larger numbers of patients should be conducted.

Adult↗
PubMed1986

Why are the many poor?

In this article the author restates the same arguments put forward in the first Fabian Tract of 1884 entitled Why Are the Many Poor? Today, mass poverty is still the central problem facing the British nation and all nations. The only long-term remedy is to restrict the power and wealth of the rich, to dismantle the present structures of social privilege, and to build social institutions based on fair allocation of wealth and on social equality. The public debate of one hundred years ago on the connections between poverty and wealth is revived in this article.

Cross-Cultural Comparison↗
PubMed1986

Potentiation of lymphocyte responses by monoclonal antibodies to the ganglioside GD3.

Previous studies have shown that the ganglioside GD3 is expressed in high concentrations on melanoma cells and that monoclonal antibodies (MAbs) against GD3 may induce partial remissions in tumor growth in patients with melanoma. The present studies indicated that incubation of interleukin 2 (IL2) dependent murine natural killer cells with several MAbs against the ganglioside GD3 potentiated the proliferative response to IL2. There was no effect on cell division in the absence of added IL2. Similarly the mitogenic response of human blood lymphocytes to phytohemagglutinin (PHA) or the T3 antigen was enhanced by coculture with these MAbs. This was noted when the MAbs to GD3 were added either before or up to 48 h after addition of PHA or MAb to T3. Kinetic analysis revealed that the potentiation of the PHA induced mitogenic response followed the expected response to PHA suggesting that the MAbs amplified normal activation pathways. These effects were also seen wih MAb to GD3 and the T10 structure on T-cells but not with MAbs to the transferrin receptor or isotype MAb controls. Studies on T-cell subsets suggested that the enhanced PHA responses were confined mainly to the T8 subset and responses of the T4 subset were not enhanced. Flow cytometric analysis revealed low levels of GD3 expression on blood lymphocytes which increased during culture with PHA. IL2 receptor (Tac epitope) expression did not show close correlation with the enhanced lymphocyte responses and the mechanism of the potentiation remains uncertain. These studies raise questions concerning the role of gangliosides in T-cell activation and whether these in vitro effects of MAbs to GD3 may account in part for their antitumor effects in patients with melanoma.

Antibodies, Monoclonal↗
PubMed1985

Inequalities in health in the city of Bristol: a preliminary review of statistical evidence.

This article compares statistical indicators of health with those of material and social deprivation for 28 wards of the city of Bristol, England. Four general indicators of health were examined-a combined rate per 1,000 live births of stillbirths and infant deaths; deaths of persons aged 15 to 64 per 1,000 of that age; deaths of persons aged 65 and over per 10,000 of that age, and numbers of babies born after 40 weeks gestation weighing less than 2,800 (and 2,500) grams per 1,000 births having that period of gestation. Measures of average and cumulative rank were used to augment tests of the significance of correlations between different indicators. The degree of rank consistency was high, and several wards at the top and the bottom of the rankings were clearly distinct on all indicators. Five indicators of deprivation were also examined-the percentages of: 1) households with fewer rooms than persons; 2) households lacking a car; 3) economically active persons seeking work; 4) children aged 5 to 15 who receive school meals free; and 5) households experiencing disconnection of electricity in the previous 12 months. Again the consistency of ranking according to the five indicators was high, with marked differences on all five indicators between the highest and lowest ranking wards. Between 1971 and 1981 some forms of deprivation increased in nearly all wards. According to some criteria, deprivation increased more in wards already most deprived in 1971 than in those least deprived. Finally, a strong association between the two sets of indicators was found. On the data available to health and planning authorities poor health is significantly correlated with deprivation. There are therefore implications for new forms of joint policy-making on the part of different departments of local and central government.

Adolescent↗
PubMed1984

Physeal, metaphyseal, and diaphyseal injuries of the lower extremities in children with myelomeningocele.

A study of 16 patients with myelomeningocele who sustained 37 fractures revealed that children with diaphyseal and metaphyseal fractures presented with local warmth, redness, swelling, and increased general body temperature, leukocytosis, and sedimentation rate. These fractures were the result of a single stress or trauma and healed uneventfully by splinting for approximately 4 weeks. In physeal injuries, which probably resulted from repetitive stresses, the systemic response was less pronounced. These injuries had to be immobilized more rigidly in plaster casts for a minimum of 8 weeks.

Adolescent↗
PubMed1982

Posterolateral spinal fusion for the treatment of scoliosis in myelodysplasia.

Twenty-seven patients have undergone posterolateral spinal fusion for the treatment of scoliosis associated with myelodysplasia. Seventeen patients were girls, and 10 were boys. The average age at the time of surgery was 10.6 years in the girls and 11 years in the boys. The average preoperative curve was 78.52 degrees. All patients were fused at the sacrum; the upper level of fusion was at the fourth thoracic vertebra in 20 patients and at the third thoracic vertebra in 7 patients. Harrington instrumentation was used in 5 patients. The average improvement in curvature was 44.5%. Based on clinical and functional criteria, 16 patients had good results, 4 patients had fair results, and 7 patients had poor results.

Adolescent↗
PubMed1981

Oral progesterone.

Explore the source record for details and available documents.

Administration, Oral↗
PubMed1981

A standardized filter paper technique for assessing nasal secretory activity.

A simple filter paper technique for estimating nasal secretory activity (NSA) was studied in 179 healthy adults. The technique was reproducible and NSA correlated independently with age and race (P less than 0.001 in each case) but not with sex or smoking habits. Subjects with a past history of atopic disease (asthma, rhinitis or eczema) produced significantly more nasal secretion than those without such a history (P less than 0.03). Among the former there was no significant difference in quantity of secretion recovered between those with and those without a past history of rhinitis. Increased NSA appears to be a marker of the atopic state and its measurement could be of value in the management of patients with allergic nasal disorders.

Adolescent↗
PubMed1981

Toward equality in health through social policy.

Although the 1979 report of the Royal Commission on the National Health Service upheld the public organization of a free health service in Britain, it did not provide a comprehensive review of the relationship between health experience, health goals, and health service policies. This paper examines recent data about trends in inequalities in health in Britain. For most age groups and for both sexes mortality rates of partly skilled and unskilled occupational classes worsened relative to those of professional, managerial, and administrative classes between the early 1950s and early 1970s. For some age groups in partly skilled and unskilled classes there has been little or no improvement in mortality rates; in others there has been absolute deterioration. There is further evidence of continuing marked inequalities in health. These must be explained in relation to class structure and inequalities in material-especially working-conditions of life. Action to redress inequalities in health must therefore lie as much outside the scope of the health and welfare services as within it. The implications of this observation for both health care and wider social policy are briefly discussed.

Advisory Committees↗