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Biomedical subjects

W Cullen

Publications and source records attributed to W Cullen.

At least 19 recordsLinked to original sources
PubMed2005

Experience of hepatitis C among current or former heroin users attending general practice.

The majority of injecting drug users in Ireland are infected with hepatitis C (HCV) and many attend general practice for methadone maintenance treatment. To describe awareness and experience of HCV infection, related investigations and treatment, a semi-qualitative interview study of current or former heroin users attending a general practice was carried out. Twenty-five patients (69% of total) were interviewed, of whom 23 were on methadone maintenance therapy at the time of the interview and 22 were HCV positive. While awareness of harm reduction measures and health implications of the infection was good, continued high-risk activity was common. Negative experiences at diagnosis, of subsequent investigations and treatments received were common. Only one person had been treated for HCV. We conclude there are a number of barriers to effective HCV management among heroin users and further research is needed to improve our understanding of this issue.

Adolescent↗
PubMed2003

"What makes a good doctor?" A cross sectional survey of public opinion.

Our understanding of the characteristics that 'make' a good doctor is continually changing. The aim of this study, therefore, was to determine the characteristics that the general public consider important in doctors who would 'treat them or a member of their family.' A cross sectional survey of 599 members of the general public was carried out. Interviewees were asked to identify three qualities, attributes or characteristics and a randomly selected 20% sample was then asked to rate the importance of previously determined characteristics in response to the same question. When presented with an open-ended question, interpersonal characteristics (eg 'someone who is friendly' and 'someone who listens') were identified as most important. When presented with a 'checklist,' however, cognitive characteristics (eg 'somebody who is intelligent and bright' and 'somebody who is knowledgeable about medical matters') were identified as most important. Both interpersonal and cognitive characteristics therefore are important qualities for doctors to possess.

Attitude of Health Personnel↗
PubMed2001

Differential effects of trivalent and pentavalent arsenicals on cell proliferation and cytokine secretion in normal human epidermal keratinocytes.

There is strong evidence from epidemiologic studies of an association between chronic exposure to inorganic arsenic (iAs) and hyperpigmentation, hyperkeratosis, and neoplasia in the skin. Although it is generally accepted that methylation is a mechanism of arsenic detoxification, recent studies have suggested that methylated arsenicals also have deleterious biological effects. In these studies we compare the effects of inorganic arsenicals (arsenite (iAs(III)) and arsenate (iAs(V))) and trivalent and pentavalent methylated arsenicals (methylarsine oxide (MAs(III)O), complex of dimethylarsinous acid with glutathione (DMAs(III)GS), methylarsonic acid (MAs(V)), and dimethylarsinic acid (DMAs(V))) in human keratinocyte cultures. Viability testing showed that the relative toxicities of the arsenicals were as follows: iAs(III) > MAs(III)O > DMAs(III)GS > DMAs(V) > MAs(V) > iAs(V). Trivalent arsenicals induced an increase in cell proliferation at concentrations in the 0.001 to 0.01 microM range, while at high concentrations (>0.5 microM) cell proliferation was inhibited. Pentavalent arsenicals did not stimulate cell proliferation. As seen in the viability studies, the methylated forms of As(V) were more cytotoxic than iAs(V). Exposure to low doses of trivalent arsenicals stimulated secretion of the growth-promoting cytokines, granulocyte macrophage colony stimulating factor and tumor necrosis factor-alpha. DMAs(V) reduced cytokine secretion at concentrations at which proliferation and viability were not affected. These data suggest that methylated arsenicals, products of the metabolic conversion of inorganic arsenic, can significantly affect viability and proliferation of human keratinocytes and modify their secretion of inflammatory and growth-promoting cytokines.

Adult↗
PubMed2000

DMPS-arsenic challenge test. II. Modulation of arsenic species, including monomethylarsonous acid (MMA(III)), excreted in human urine.

The administration of sodium 2,3-dimercapto-1-propane sulfonate (DMPS) to humans chronically exposed to inorganic arsenic in their drinking water resulted in the increased urinary excretion of arsenic, the appearance and identification of monomethylarsonous acid (MMA(III)) in their urine, and a large decrease in the concentration and percentage of urinary dimethylarsinic acid (DMA). This is the first time that MMA(III) has been detected in the urine. In vitro biochemical experiments were then designed and performed to understand the urinary appearance of MMA(III) and decrease of DMA. The DMPS-MMA(III) complex was not active as a substrate for the MMA(III) methyltransferase. The experimental results support the hypothesis that DMPS competes with endogenous ligands for MMA(III), forming a DMPS-MMA complex that is readily excreted in the urine and points out the need for studying the biochemical toxicology of MMA(III). It should be emphasized that MMA(III) was excreted in the urine only after DMPS administration. The results of these studies raise many questions about the potential central role of MMA(III) in the toxicity of inorganic arsenic and to the potential involvement of MMA(III) in the little-understood etiology of hyperkeratosis, hyperpigmentation, and cancer that can result from chronic inorganic arsenic exposure.

Adult↗
PubMed2000

Experience of heroin overdose among drug users attending general practice.

BACKGROUND: Heroin overdose is responsible for significant mortality. It has not previously been highlighted as an important prevention or care issue for general practitioners (GPs) involved in the management of drug misuse. AIMS: To examine the prevalence and experience of heroin overdose in a population of drug users attending a general practice. METHOD: A questionnaire-based interview of drug users attending a general practice in Dublin, Ireland. RESULTS: Twenty-four (73% of estimated total) drug users were interviewed. Although 17 (71%) were on recognised methadone treatment programmes, 10 (42%) were still injecting heroin. A total of 23 (96%) had witnessed an overdose, with 10 (42%) having been victims of overdose themselves. Twenty-two (92%) knew a victim of fatal overdose, with four (17%) having been present at a fatal overdose. The interviews revealed high levels of activity associated with overdose and poor use of preventive measures. CONCLUSION: The issue of prevention and management of overdose should become a priority for GPs caring for opiate-dependent patients.

Adult↗
PubMed2000

Drug users attending general practice in Eastern Regional Health Authority (ERHA) area.

Dublin has an estimated 13,460 opiate drug users. The role of general practice in providing care for this group has increased over the last four years. A Central Methadone Treatment List (CMTL) registers all clients currently on treatment. To obtain a social, demographic and drug using profile of opiate users attending general practitioners (GPs) for methadone maintenance. A cross sectional survey of opiate users attending general practice for methadone maintenance in the Dublin area in early 1999. Data was collected on 571 clients (62% of total number attending general practice), of whom 97% had used heroin in the past and 12% had never injected. Although clients had been receiving methadone maintenance in general practice for a mean of 14 months, 16% were still using heroin, of whom 31% were still injecting. The mean age of first drug use was 15.5 years and of first injecting was 19.4 years. Younger clients are starting both to use drugs and inject drugs at an earlier age. Record keeping was good, with most items of information present in over 70% of the charts surveyed. A total of 17% of clients recorded on the CMTL could not be traced to the GP recorded as providing care. Despite treatment with methadone maintenance, there is a high level of continued risk activity in this group. Furthermore, a trend towards earlier initiation to drug use is apparent. The CMTL registration process requires further exploration.

Adolescent↗
PubMed1999

A one year prospective census of workload and process at a community hospital casualty room.

A prospective census of patients attending the casualty room of Wicklow District Hospital (a general practitioner operated service) for one year was performed. A total of 1564 attendances were recorded, of which 904 (58%) were male and 953 (61%) were eligible for free medical care. Almost half, 735 (47%) attended outside daytime hours. Concerning type of presentation, 637 (41%) attended with acute trauma, 450 (29%) attended with acute medical and 477 (30%) attended with elective problems. Repeat visits accounted for 5% of the total. Concerning outcome of consultation, 409 (26%) were given a prescription, 307 (20%) had blood tests, 263 (17%) received dressings, 183 (12%) were referred to secondary care, 168 (11%) were followed up by their GP, 146 (9%) had minor surgery, and 86 (5%) had no intervention. This study indicates that the hospital is responsible for a considerable workload, with a significant out of hours component.

Emergencies↗
PubMed1994

Depletion of the erbB-2 gene product p185 by benzoquinoid ansamycins.

Herbimycin A, a benzoquinoid ansamycin, is widely used as an inhibitor of tyrosine kinases. We have examined the effects of herbimycin A and several analogues on p185, the tyrosine kinase encoded by the erbB2 gene in human breast cancer cells. Exposure to 0.35 microM herbimycin A reduced tyrosine phosphorylation of p185 in SKBr3 cells by 80% after 2 h, and the p185 protein level was reduced by 90% after 6 h. The reduction of p185 resulted primarily from increased degradation of p185; cellular protein synthesis was reduced only 16% in SKBr3 cells treated with herbimycin A, RNA synthesis was inhibited only 10%, and erbB2 mRNA levels were unchanged. Examination of the major cellular glycoproteins indicated that most glycoproteins were unaffected under conditions that substantially depleted p185. Studies with cell lines transfected with erbB2 containing defined deletions indicated that susceptibility to the depletion of p185 by herbimycin and its analogues required the domain encoded by amino acids 751-971. The benzoquinoid ansamycins therefore initiate a process of specific degradation of tyrosine kinases by a mechanism that remains unknown.

Anti-Bacterial Agents↗
PubMedDate not supplied

Hepatitis C infection among drug users attending general practice.

BACKGROUND: The prevalence of hepatitis C (HCV) infection among injection drug users is high and addiction-related care is increasingly being provided by GPs in Ireland. AIMS: To determine the prevalence and associated factors of HCV infection among injecting drug users attending general practice. METHODS: The records of 571 patients attending 42 general practices in the Eastern Regional Health Authority (ERHA) area for methadone maintenance treatment were reviewed. RESULTS: The HCV status was recorded in 380 cases (67%). Of these, 193 had a test performed by their GP, 74 had been tested by another service and 113 had no evidence of being tested, but HCV status was recorded based on information provided by the patient himself. A total of 276 cases were identified as being HCV positive (prevalence 73%), with no difference in prevalence between the three sources of information (p = 0.12). A history of injecting drug use was the major determinant of testing for HCV. CONCLUSIONS: While a large proportion of drug users attending GPs for methadone maintenance treatment are known to be HCV positive, a considerable number have not been tested. Barriers to testing need to be explored to facilitate comprehensive screening.

Adult↗
PubMedDate not supplied

Undergraduate medical students' experience in general practice.

BACKGROUND: Increasingly, undergraduate medical education is becoming community-based. Logbooks are a useful tool in documenting the range of clinical exposure and learning opportunities available to students during clinical training, particularly where the role of new clinical settings for training medical students is being explored. AIMS: To describe the clinical experience of medical students during an undergraduate programme in general practice at an Irish University. METHODS: Medical students in the fifth year of medical school were asked to record data from 20 consecutive consultations during a clinical attachment in general practice. RESULTS: A total of 186 students (82% of total) recorded data on 3,710 consultations. The patient population encountered was similar in demography and morbidity profile to other general practice populations, with hypertension, preventive immunisation and cough the most frequently encountered diagnostic labels. Respiratory illness and circulatory illness were the most frequently encountered primary and secondary presentations, respectively. An active role was adopted by students in almost half of all consultations. CONCLUSIONS: This paper provides evidence that general practice in Ireland is a setting in which medical students can both encounter a wide range of clinical problems and engage in active learning processes.

Education, Medical, Undergraduate↗
PubMedDate not supplied

Profile of attendance at a maternity hospital emergency room.

BACKGROUND: Direct presentations to secondary care that could have been managed in primary care have been the subject of much study. Social factors may influence the decision to present directly to secondary care services. AIM: To determine the profile and primary care service use of patients attending a maternity hospital emergency room (ER). METHODS: A self-administered, questionnaire based, cross-sectional study was performed over a period of one month. RESULTS: Of 350 patients attending the ER, 343 (98%) completed a questionnaire. Mean age of patients attending was 28 years (range 16-65). Thirty seven per cent were eligible for free medical care and 39% belonged to socio-economic group six. Fifty nine per cent attended outside normal hours, 31% had a female general practitioner (GP) and 38% were referred by a GP to the ER. Twenty eight per cent had seen their GP in the previous three days, 31% had consulted a GP with their current problem and 58% felt "comfortable" or "very comfortable" attending their GP with a gynaecological complaint. CONCLUSIONS: This study indicates that the service is responsible for a considerable workload, with a low level of use of primary care services by those attending.

Adolescent↗
PubMedDate not supplied

Hepatitis C among drug users: consensus guidelines on management in general practice.

BACKGROUND: Hepatitis C (HCV) is a common cause of morbidity among patients who attend general practitioners (GPs) in Ireland for methadone maintenance treatment. AIMS: To describe the development and content of guidelines for the management of HCV among current or former opiate users in the Eastern Regional Health Authority area attending GPs for methadone treatment. METHODS: The guidelines were produced in five stages: identification of key stakeholders; development of evidence-based draft guidelines; discussion of content; determination of 'Delphi'-facilitated consensus and review by a sample of GPs for whom the guidelines would be intended. RESULTS: The guidelines contain advice for GPs on all aspects of care of patients at risk of HCV, including general and preventative care, care of other bloodborne and hepatotoxic viruses, and the factors to be considered and appropriate evaluation prior to referring a patient for assessment at a hepatology unit. CONCLUSIONS: GPs have an important role to play in the care of patients at risk of, or infected with, HCV.

Adolescent↗
PubMedDate not supplied

Prevalence of fatigue in general practice.

BACKGROUND: Fatigue is an important symptom in general practice due to its association with physical, psychological and social problems. AIM: To determine the prevalence of fatigue as an unsolicited symptom during general practice consultations. METHODS: A random sample of GPs practising in Ireland was invited to provide data on consultations held over one day. Data were recorded on the presence of fatigue as a main or supporting symptom, social and demographic characteristics. RESULTS: Data were recorded by 89 GPs on 1,428 consultations. The prevalence of fatigue was 25%. It was the main reason for attending the doctor in 6.5% and a secondary reason in 19%. Sixty-two per cent of patients were female and 48% were eligible for free GP services. The mean age was 47.1 years. The presence of fatigue was associated with: attending a female GP, being female, attending a GP who had been qualified for fewer years and attending the GP frequently. CONCLUSION: The prevalence of fatigue reported in this study is over three times higher than that reported in earlier work. Doctor characteristics appear to be as important as patient characteristics in determining fatigue.

Family Practice↗
PubMedDate not supplied

Guidelines for the management of hepatitis C in general practice: a semi-qualitative interview survey of GPs' views regarding content and implementation.

BACKGROUND: Hepatitis C is a common infection among people who attend GPs for methadone maintenance treatment. AIM: To determine the views of GPs towards clinical guidelines for the management of hepatitis C among current or former injecting drug users in advance of their implementation. METHODS: A purposive sample of 14 GPs (10% of the total prescribing methadone at the time the guidelines were developed) was invited to review a pre-publication draft of the guidelines and interviewed regarding content, presentation, perceived barriers to implementation and suggested interventions to facilitate effective implementation of the guidelines. RESULTS: GPs indicated the guidelines were useful but suggested aspects of presentation should be clarified. Organisational issues were identified as the principal barriers to effective implementation, with the provision of additional nursing support the principal intervention suggested to facilitate implementation. CONCLUSIONS: Interviewing intended recipients may be an important step in ensuring clinical practice guidelines are effectively implemented.

Attitude of Health Personnel↗
PubMedDate not supplied

Schizophrenia in general practice: a national survey of general practitioners in Ireland.

BACKGROUND: Chronic schizophrenia is challenging to manage in primary care. AIMS: We sought to establish the views of General Practitioners about managing patients with chronic schizophrenia in primary care. METHODS: A cross-sectional, postal survey questionnaire of a randomly selected sample of 20% of GPs was carried out. RESULTS: Most GPs (97.2%) have at least one person with schizophrenia attending their practice. A substantial number of GPs (22.2%) treat cases of schizophrenia without specialist input following an initial referral to psychiatric services. Almost all (88.7%) advised patients who had experienced multiple relapses to remain on medication indefinitely. One third of GPs reported that they always experience difficulties managing patients with schizophrenia in their practice. Non-adherence with prescribed medication and loss to follow-up were the commonest impediments to treatment encountered. CONCLUSION: GPs require appropriate back up from specialist services to enable their management of chronic schizophrenia.

Adult↗