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Biomedical subjects

P W Jones

Publications and source records attributed to P W Jones.

At least 19 recordsLinked to original sources
PubMed1992

Teachers' perceptions of epilepsy.

A questionnaire survey undertaken among 142 schoolteachers in North Staffordshire revealed most of the respondents did not feel confident when teaching children who had epilepsy and a minority considered their knowledge of the subject to be adequate. Only four teachers had received recent specific instruction on childhood epilepsy and the majority requested training on epilepsy and other medical conditions. Despite this lack of confidence and specific training, the respondents demonstrated good general knowledge of epilepsy and adequate awareness of the difficulties encountered by epileptic schoolchildren. If optimal care is to be achieved for children with epilepsy, then teachers must feel confident with this subject. School health services have a clear role in ensuring that teachers have sufficient knowledge of childhood epilepsy, that they have adequate support, and that communication between teachers, parents, and paediatricians is encouraged.

Adult↗
PubMed1992

A self-complete measure of health status for chronic airflow limitation. The St. George's Respiratory Questionnaire.

A need was identified for a fixed-format self-complete questionnaire for measuring health in chronic airflow limitation. A 76-item questionnaire was developed, the St. George's Respiratory Questionnaire (SGRQ). Three component scores were calculated: symptoms, activity, and impacts (on daily life), and a total score. Three studies were performed. (1) Repeatability was tested over 2 wk in 40 stable asthmatic patients and 20 patients with stable COPD. The coefficient of variation for the SGRQ total score was 19%. (2) SGRQ scores were compared with spirometry, 6-min walking distance (6-MWD), MRC respiratory symptoms questionnaire, anxiety, depression, and general health measured using the Sickness Impact Profile score. A total of 141 patients were studied, mean age 63 yr (range 31 to 75) and prebronchodilator FEV1, 47% (range 11 to 114%). SGRQ scores correlated with appropriate comparison measures. For example, symptom score versus frequency of wheeze, r2 = 0.32, p less than 0.0001; activity versus 6-MWD, r2 = 0.50, p less than 0.0001; impact versus anxiety, r2 = 0.38, p less than 0.0001. Multivariate analysis demonstrated that SGRQ scores summed a number of areas of disease activity. (3) Changes in SGRQ scores and other measures were studied over 1 yr in 133 patients. Significant correlations were found between changes in SGRQ scores and the comparison measures (minimum r2 greater than 0.05, p less than 0.01). Multivariate analysis showed that change in total SGRQ score summed changes in a number of aspects of disease activity. We conclude that the SGRQ is a valid measure of impaired health in diseases of chronic airflow limitation that is repeatable and sensitive.

Aged↗
PubMed1992

Health visitors and child accident prevention.

Yvonne H Carter, Michael J Bannon and Peter W Jones explore the role of health visitors in child accident prevention in North Staffordshire, to assess their knowledge and awareness of local data and to facilitate more effective planning of educational provision for health visitors and other primary health care workers.

Accident Prevention↗
PubMed1991

Image compression techniques for medical diagnostic imaging systems.

As a result of recent technological advances, a significant (and increasing) number of the images in a typical radiology department are represented in digital form. This includes images that have been captured using digital imaging modalities such as computed tomography and magnetic resonance imaging as well as images that have been digitally converted from film originals as in computed radiography. To provide economical storage of such images and to allow for their efficient transmission over various networks, it becomes necessary to consider digital image compression techniques. In this article, the fundamental concepts of several popular reversible and nonreversible image compression schemes are reviewed. In addition, the performance of the schemes in terms of compression ratio and reconstructed image quality as applied to medical diagnostic images is investigated.

Diagnostic Imaging↗
PubMed1991

Oral vaccination of calves against experimental salmonellosis using a double aro mutant of Salmonella typhimurium.

An attenuated derivative of the fully calf virulent Salmonella typhimurium strain ST4/74 was constructed by introducing stable mutations into genes aroA and aroD rendering the strain dependent for growth on aromatic compounds. The strain (BRD562) was used to vaccinate orally ten Friesian calves 7 days after birth with approximately 10(10) live organisms. The only effects of vaccination in the calves was a transient faecal excretion of the organism, mild transient diarrhoea and mild pyrexia in one animal. Two of these animals were tested for the presence of BRD562 at necropsy 56 days after birth but none were shown to be infected. Eight of the vaccinated calves were subjected to an oral challenge infection with ST4/74 28 days after vaccination and seven out of the eight animals survived. The only effect of challenge in the surviving calves was mild pyrexia and transient excretion of ST4/74 in their faeces; only one of the seven animals was found to be infected at necropsy 28 days after challenge. The eighth challenged calf scoured severely and was killed in extremis 7 days after challenge. Four unvaccinated control calves infected orally with ST4/74 28 days after birth all scoured severely and were euthanased for humane reasons 5-7 days later. This study suggests that vaccination with an attenuated strain of S. typhimurium harbouring mutations in two aro genes is a safe and effective way of protecting young calves against experimental S. typhimurium infection.

Administration, Oral↗
PubMed1991

The St George's Respiratory Questionnaire.

The St George's Respiratory Questionnaire is a standardized self-completed questionnaire for measuring impaired health and perceived well-being ('quality of life') in airways disease. It has been designed to allow comparative measurements of health between patient populations and quantify changes in health following therapy. The background and rationale for its development are discussed together with an analysis of its performance.

Chronic Disease↗
PubMed1991

Palliation and life quality in lung cancer; how good are clinicians at judging treatment outcome?

A recent trial by the MRC Lung Cancer Working Party used physician assessments to compare two palliative schedules of radiotherapy in lung cancer. A prospective study has been undertaken on a subset of these trial patients to see how physician assessments of symptomatic relief and general condition correlate with patient perception of therapeutic response. In 40 patients followed up monthly from presentation until close to death, good agreement was found between doctors and patients on change in specific physical symptoms and overall physical condition. Doctors were poor judges of life quality at presentation but appeared able to identify relative improvement or deterioration in overall quality of life. In conclusion, physician assessments may constitute valid end-points for radiotherapy trials comparing palliative schedules in lung cancer.

Aged↗
PubMed1991

Differentiation between the intensity of breathlessness and the distress it evokes in normal subjects during exercise.

1. This study was designed to examine whether normal subjects could differentiate between the 'intensity' of their breathlessness and the amount of 'distress' it evoked, by specific wording of the instructions. 2. A preliminary study showed no significant difference between 'distress' score during exercise measured on two separate occasions (P = 0.3). 3. Ten subjects each performed two identical incremental cycle-ergometer exercise tests on separate occasions during which they were asked to quantify either 'intensity' or 'distress' by using modified Borg scales. 4. In all subjects there was a significant correlation (P less than 0.001) between 'intensity' and minute ventilation. In eight subjects there was a significant correlation (P less than 0.05) between 'distress' and minute ventilation. One subject displayed no significant correlation and one registered no distress. 5. Mean 'intensity' was greater than the mean 'distress' (P = 0.0001). The slope of 'intensity'/minute ventilation was greater than the slope of 'distress'/minute ventilation (P = 0.0001). 6. Within individuals there was a significant correlation between 'intensity' and 'distress' (P less than 0.05). There was a wide scatter in the slope of this relationship between subjects and maximum 'intensity' and 'distress' did not correlate. 7. Different elements of the breathlessness sensation could be identified and selectively measured depending on the wording of the instructions given to the subject. 8. There was a wide intersubject variation in the magnitude of both breathlessness 'intensity' and 'distress' estimates, but the differences between subjects in these two components of the sensation did not appear to follow a common pattern.

Adult↗
PubMed1991

Long-term reproducibility of Borg scale estimates of breathlessness during exercise.

1. The intensity of breathlessness in normal subjects during exercise was measured on seven occasions over a 40-week study period to assess the long-term repeatability of Borg scale estimates of breathlessness. 2. In all subjects there was a significant correlation (P = 0.0001) between breathlessness and minute ventilation. Minute ventilation measured at each work rate did not differ between the seven exercise tests (P greater than 0.05). 3. There was no significant difference between the mean Borg scores (measured with respect to a given level of ventilation) in 5 of the 7 test weeks (P greater than 0.05). The slope of the relationship Borg score/minute ventilation did not differ between the seven exercise tests (P greater than 0.05). 4. Breathlessness estimation was highly reproducible both after 1 week and after 40 weeks of the study (both P greater than 0.05). 5. The duration without testing between consecutive tests did not affect reproducibility: the mean Borg score was as equally reproducible after an interval of 22 weeks without testing as after an interval of 1 week (P greater than 0.05). 6. The Borg scale provides a reliable technique for studying the sensation of breathlessness over extended time periods.

Adult↗
PubMed1991

Developmental profile of plasma proteins in human fetal cerebrospinal fluid and blood.

Total protein, alphafetoprotein, albumin, prealbumin, alpha-1-antitrypsin, transferrin and ceruloplasmin levels were measured in samples of human fetal and neonatal cerebrospinal fluid (CSF) (97 cases), obtained between 12 and 41 weeks of gestation. In 39 of these cases (13 to 40 weeks gestation) plasma was also available for comparative analysis. CSF was collected from lateral ventricles in the first half of gestation and from the lumbar region in the second. Since these CSF samples were obtained from different sites, the protein levels in the lateral ventricle (early) samples could not be compared directly with those in the lumbar (later) samples. However, the mean protein levels in the lumbar samples were lower than those in the ventricular samples, which is in accord with the decline in CSF protein levels described in maturing animal fetuses. Despite a wide scatter of results, particularly in the first half of gestation, significant decline in the level of CSF alphafetoprotein was demonstrated during both first and second halves of gestation, and of albumin and prealbumin in the second half. No sex differences were found except for ceruloplasmin in lumbar CSF later in gestation, when males had higher levels than females. In fetal plasma, protein levels increased with increasing gestation apart from alphafetoprotein and prealbumin which both declined progressively. CSF/plasma ratios were dissimilar for different proteins, and changed with increasing gestation. These findings support the concept that the human fetal blood brain barrier matures early.

Blood Proteins↗
PubMed1991

What do parents expect antenatally and do babies teach them?

Antenatal inquiry of 658 parents in the North Staffordshire District Health Authority showed at least 13% to lack knowledge about a baby's potential for personal interaction when under 1 week old. Mothers and fathers varied significantly, independent of parity. Experienced parents expected later smiles. Two hundred and seventy eight of the same families were questioned three to four months after birth. Most parents had observed their baby's early responsiveness. Specific responses (Looking, listening) were noted earlier when anticipated and looked for. Significant among postnatal non-responders was their antenatal selection of predominantly impersonal stimulation for a baby. The greatest degree of warmth noted in postnatal observations correlated notably with a father's antenatal interest and postnatal support from him and their friends, a mother's commitment to breast feeding and her knowledge that a very young baby can see, like faces, and cries for emotional reasons. This highlights areas for antenatal tuition and postnatal encouragement, aiming to enhance warm early mutual regard between parents and child.

Adolescent↗
PubMed1991

Randomised controlled trial of the effectiveness of a respiratory health worker in reducing impairment, disability, and handicap due to chronic airflow limitation.

A randomised controlled trial was undertaken to determine whether a respiratory health worker was effective in reducing the respiratory impairment, disability, and handicap experienced by patients with chronic airflow limitation attending a respiratory outpatient department. The 152 adults (aged 30-75 years) who participated had a prebronchodilator forced expiratory volume in one second (FEV1) below 60% predicted and no other disease. They were randomised to receive the care of a respiratory health worker or the normal services provided by the outpatient department. The respiratory health worker provided health education and symptom and treatment monitoring in liaison with primary care services. After one year there was little difference between the two groups in spirometric values (FEV1 and forced vital capacity before and after salbutamol 200 micrograms), disability (six minute walking distance and paced step test), and handicap (sickness impact profile, hospital anxiety and depression scale). Patients not looked after by the respiratory health worker were more likely to die (relative risk 2.9 (95% confidence limits 0.8, 10.2); when age and FEV1 were controlled for this risk increased to 5.5 (95% confidence limits 1.2, 24.5). Patients looked after by the respiratory health worker attended their general practitioner more frequently and were prescribed a greater range of drugs. This is the third study to have found limited measurable benefit in terms of morbidity from the intervention of a respiratory health worker. This may be due to the ability of such workers to keep frail patients alive.

Adult↗
PubMed1991

Influence of demographic and disease related factors on the degree of distress associated with symptoms and restrictions on daily living due to asthma in six countries.

To investigate the influence of demographic and physiological variables on the degree of distress associated with asthma, 124 patients were recruited from six countries. All patients responded to 76 items relating to symptoms and impacts of asthma on daily living by marking a 10 cm visual analogue scale (VAS) to indicate the degree of distress associated with any particular item. The influence of three factors, age, sex and forced expiratory volume in one second (FEV1), on these VAS scores was investigated. Differences between patients accounted for 13.4% of the total variance (sum of squares) in VAS scores. There were no significant effects of sex, age or FEV1 on VAS score (p greater than 0.05 in each case). The separate proportionate contribution of each of these three factors to the total variance in item scores ranged from 0.02% (FEV1) to 0.2% (sex). There were significant differences between the mean VAS scores from the six countries (p less than 0.01) but these differences contributed to only 3.6% of the total variance in the measured VAS scores. We conclude that demographic and disease related factors account for very little of the differences in the degree of distress that patients attach to the symptoms and effects of asthma. We suggest that it is possible to make meaningful comparisons between countries of the impact of asthma on patients' lives.

Activities of Daily Living↗
PubMed1990

Oxpentifylline treatment of venous ulcers of the leg.

OBJECTIVE: To determine the effect of oxpentifylline on the healing of venous ulcers of the leg. DESIGN: Double blind, randomised, prospective, placebo controlled, parallel group study. SETTING: Four outpatient clinics treating leg ulcers in England and the Republic of Ireland. PATIENTS: 80 Consecutive patients with clinical evidence of venous ulceration of the leg in whom appreciable arterial disease was excluded by the ratio of ankle to brachial systolic pressure being greater than 0.8. INTERVENTIONS: All patients received either oxpentifylline 400 mg three times a day by mouth or a matching placebo for six months (or until their reference ulcer healed if this occurred sooner) in addition to a locally standardised method of compression bandaging. MAIN OUTCOME MEASURES: The primary end point was complete healing of the reference ulcer within six months. The secondary end point was the change in the area of the ulcer over the six month observation period. RESULTS: Complete healing of the reference ulcer occurred in 23 of the 38 patients treated with oxpentifylline and in 12 of the 42 patients treated with a placebo. Life table analysis showed that the proportion of ulcers healed at six months was 64% in the group treated with oxpentifylline compared with 34% in the group treated with a placebo (log rank test chi 2 = 4.78, p = 0.03), which was significant (odds ratio = 1.81, 95% confidence interval 1.20 to 2.71). CONCLUSION: Oxpentifylline used in conjunction with compression bandaging improves the healing of venous ulcers of the leg.

Double-Blind Method↗
PubMed1990

A single oral dose method for predicting steady state theophylline concentrations in clinical practice.

A single dose, single point method of predicting patients' oral maintenance theophylline dosage has been compared with a noninvasive method. Twenty patients with obstructive lung disease received an oral dose (6 mg kg-1) of micro-crystalline theophylline. The plasma theophylline concentration after 8-10 h was then used to calculate the optimum maintenance dose of sustained release aminophylline required to achieve steady state concentrations between 55 and 110 mumols l-1. The mean steady state plasma theophylline concentration for this dosage schedule was also predicted by a method using population average pharmacokinetic parameters (assumed clearance method). These predictions were then compared with observed concentration-time profiles at steady state. The mean difference between the observed values and those predicted from a morning test dose was -0.11 mumol l-1 (95% CI -7.0 to +7.2). A larger difference (-7.4 mumol l-1 95% CI -18.2 to +3.4) was found for the assumed clearance method. Since the confidence intervals contain zero, these differences are not significantly different from zero at the 5% level, although the morning test dose method allowed prediction of the whole concentration-time profile and was more precise. An evening test dose was also used in the study, but the mean difference between the observed values and those predicted from this method was larger at -24.8 mumol l-1 (95% CI -32.89 to -17.21) and was significantly different from zero. This study indicates that a morning test dose followed by a single blood sample can be used to establish maintenance theophylline therapy quickly and safely in selected patients.

Adult↗