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Biomedical subjects

W Fox

Publications and source records attributed to W Fox.

At least 37 records · Page 2Linked to original sources
PubMed1984

A novel system to obtain addresses of out-patients--assessment in routine clinic practice in Madras, S. India.

A novel method of obtaining accurate home addresses from out-patients was introduced as a routine procedure in 6 chest clinics of Madras City, following highly satisfactory results under study conditions. In this method, the patient is given a card (the address card), and asked to get his exact address entered on it by any knowledgeable person of his choice such as a landlord or neighbour. An assessment of the system was undertaken after it had been in operation for about 8 months. A complete and legible address was available for 82% of 3956 patients, the range in the 6 clinics being 74% to 91%. The main causes for failure were: not giving address card to patient (7%), patient not reattending the clinic (6%), and patient reattending but not returning the address card (3%). Corrective measures have now been introduced, and a re-assessment will be undertaken in due course.

Ambulatory Care Facilities↗
PubMed1984

Study of case-finding for pulmonary tuberculosis in outpatients complaining of a chronic cough at a district hospital in Kenya.

This investigation is the fifth in a series of case-finding studies in Kenya. It explores the potential for case-finding by the identification of persons with suspected tuberculosis (persons with a cough for 1 month or more) through careful screening of general outpatients attending a district hospital. Of 601 suspects identified among 20,756 new outpatients attending hospital during a period of 11 wk, 5.6% were considered by an independent assessor to have active pulmonary tuberculosis (2.2% with sputum positive on both smear and culture, 1.2% on culture only, and 2.2% negative sputum but radiographically active lesions). A further 2.0% were considered to have inactive tuberculosis. This method of case-finding appears to be uniformly effective within a radius of approximately 9 miles of the hospital, becoming less effective outside this range. There were certain important diagnostic pointers. There was an excess of tuberculosis cases in males, in those with weight loss, in those with a history of cough of less than a year, in those with a history of hemoptysis, and in those 35 yr of age or older. This investigation provides additional support to our previous studies, which demonstrated serious problems of case-finding in the peripheral health units and suggests that unless the infrastructure of primary health care at the periphery can be improved, the policy should be to diagnose tuberculosis in the district hospital and to operate a simple referral system for persons with suspected tuberculosis from the periphery.

Adolescent↗
PubMed1984

Bone and joint tuberculosis. A survey of notifications in England and Wales.

Of the 4172 patients in a survey of all cases of tuberculosis notified in a six-month period in England and Wales in 1978-79, 198 had a bone or joint lesion; 79 were white and 108 were of Indian subcontinent (Indian, Pakistani or Bangladeshi) ethnic origin. The estimated annual notification rates for orthopaedic tuberculosis were 29 per 100 000 for the Indian subcontinent group and 0.34 per 100 000 in the white group, a ratio of 85 to 1. Rates increased with age in both groups. The spine was the most common site, and was affected in 30% of the white patients and 43% of the Indian subcontinent patients; the distribution of other sites was similar in both groups. Positive culture from a bone or joint lesion was obtained in 99 (50%) of the 198 patients (58% of white patients and 47% of the Indian subcontinent patients). Bacteriological or histological confirmation of tuberculosis either from a bone or joint lesion or from another site was obtained in 68% of the patients. Mycobacterium tuberculosis was isolated from the orthopaedic lesions in 79 of the 82 patients with identification test results and M. bovis in the 3 remaining patients. Of the 61 patients with M. tuberculosis and with no history of previous chemotherapy, 5 had resistant strains compared with 1 of the 18 patients who had previously received chemotherapy. All 6 patients with resistant strains were of Indian subcontinent ethnic origin.

Adolescent↗
PubMed1984

Deaths occurring in newly notified patients with pulmonary tuberculosis in England and Wales.

In a survey of the chemotherapy prescribed for 1312 adult patients of white or Indian subcontinent ethnic origin with pulmonary tuberculosis only, notified in the 6 months from October 1978 to March 1979, it was found that 163 (12%) patients died before they had completed chemotherapy. Of the 163 patients who died 96% were of white ethnic origin; 15% of the 1022 white patients died compared with 2% of the 290 Indian subcontinent patients. According to the death certificate, approximately half the white patients died from tuberculosis, and in a further 31% tuberculosis was a contributory factor. Death from tuberculosis most frequently occurred in the older age groups, accounting in part for the different findings in these two ethnic groups, because of the excess of older white patients. In a step-wise multivariate discriminant analysis death from tuberculosis was found to be significantly associated in the white patients with the radiographic extent of disease before treatment, and with age, extent of cavitation and a positive sputum smear result, but not sex. Most of the deaths from tuberculosis occurred early, 38% before the end of the first week of chemotherapy and 69% by the end of 4 weeks. There was a further group of 51 adult patients with pulmonary tuberculosis notified in the same 6-month period in whom the diagnosis was not made until after death, 25 of them dying from tuberculosis. It is concluded that there is still a substantial risk of death from tuberculosis in patients with extensive disease in the older age groups.

Adolescent↗
PubMed1982

Study of a policy to minimise the prescription of medicaments at first attendance at chest clinics.

In chest clinics in Madras, south India, medicaments are prescribed to many patients at the first clinic attendance, whether necessary on medical grounds or not, in the belief that this practice will increase the likelihood of the patients subsequently reattending the clinic. This study of 2608 patients in four chest clinics showed that the proportion prescribed medicaments ranged from 50% to 75%. Subsequently, a modified policy of prescribing medicaments only when they were medically essential was investigated on 956 patients in the largest of these clinics. The policy was found to be practicable, and it did not have any adverse consequences such as an increased rate of default or an unacceptable level of patient dissatisfaction. The advantages of the new policy are savings in money, man-power, and time and the potential for a reduction in the incidence of side-effects.

Adult↗
PubMed1981

A third study of case-finding methods for pulmonary tuberculosis in Kenya, including the use of community leaders.

Five methods of identifying tuberculosis suspects were investigated in the Machakos District of Kenya by: (1) 3-monthly interrogation of the Community Elders, (2) interrogation of household heads, (3) identifying suspects amongst outpatients attending local health units, (4) examination of patients registered during the previous 10 years in the District Tuberculosis Register and also (5) their close contacts. Sputum was bacteriologically examined by smear and culture from suspects found by all the methods. The initial interrogation of the Elders yielded 216 suspects, of whom 9 were culture-positive, including 6 smear-positive. Reinterrogating the Elders 4 times at 3-monthly intervals produced a further 114 suspects including 4 culture-positive cases (3 being smear-positive). The examination of a second sputum specimen from suspects after a 3-month interval yielded 4 further culture-positive cases (all smear-negative) but the examination of a third specimen after a further 3 months yielded no further cases. A single interrogation of 1093 household head suspects yielded 22 culture-positive cases, including 11 smear-positive. The response in 5 health units covering a population of about 24 500 was poor. During a 2-year period only 109 suspects were recorded; 7 were culture-positive, including 3 smear-positive. Of 61 cases of tuberculosis registered during the previous 10 years, 8 were currently culture-positive, 5 being smear-positive. Of 318 household contacts of these cases, 6 were culture-positive cases, 2 being smear-positive. The problems presented by different active case-finding methods are discussed, identifying those that appear promising and those unpromising.

Adolescent↗
PubMed1981

A randomised study of two policies for managing default in out-patients collecting supplies of drugs for pulmonary tuberculosis in a large city in South India.

A randomized controlled study was undertaken to compare 2 policies of default management in out-patients with smear-negative pulmonary tuberculosis attending a large chest clinic in Madras city. All the patients were due to collect monthly supplies of drugs for a year, for daily self-administration at home. In the routine (R) policy, if a patient failed to collect the drug supply on a due date, a reminder letter was posted on the fourth day and, if necessary, a health visitor visited the home a week later. In the intensive (I) policy, a health visitor visited the home on the 4th day and, if necessary, a week later and at 1 and at 2 months. The main analyses concern 150 patients (75 R, 75 I), of whom 16 R and 15 I patients had a positive culture. A total of 29 patients (11 R, 18 I) did not default at any time. For the remaining 64 R and 57 I patients, the mean numbers of defaults were 3.0 and 2.3, and the mean numbers of defaulter retrieval actions were 4.3 and 3.8, respectively. The home visit as the first action (I series) was successful in retrieving defaulters on 65% of 132 occasions, while the reminder letter (R series) was successful in 56% of 193 occasions (P = 0.1). Following the second action, which was a home visit in both the series, these proportions became 80% and 84%, respectively. in the I series, 22 third and 18 fourth actions were taken, but the patient was retrieved in only 4 and 0 instances respectively. The mean number of drug collections during the year was significantly higher in the I series (9.8) than in the R series (8.6). Finally, the proportions of patients who made 12 collections in a 15-month period, a satisfactory target under Indian Programme conditions, were 69% and 52%, respectively (P = 0.07).

Adolescent↗
PubMed1981

A survey of deaths in Hong Kong attributed to tuberculosis.

Records obtained for 578 (96%) of the 602 patients certified as having died from tuberculosis in Hong Kong during a 1-year period were reviewed by an expert independent assessor in London, In his opinion 14 (2% of the 578) had never had tuberculosis, and in 28 (5%) it was not possible to decide whether or not the patient had ever had tuberculosis. Tuberculosis had been no more than a contributory factor in causing death in 44 (8%), in 29 (5%) it was irrelevant, and in 33 (6%) it was not possible to determine what role it had played. The remaining 430 (74%) patients were considered actually to have died from tuberculosis, 307 from active disease and 123 from the late effects of inactive disease. If all 578 patients had died from tuberculosis this would represent a death rate for the survey year of 13.1 per 100 000 of the population. The rate falls to 9.7 per 100 000 if based on the 430 patients considered by the assessor to have died from tuberculosis, a reduction of 26%. Since the annual death rate from active disease (6.9 per 100 000 in this survey) is a better index of the current efficiency of an antituberculosis programme than the total death rate, it is suggested that efforts should be made to obtain and publish separate annual rates for deaths from active and from inactive tuberculosis. An analysis of potentially avoidable delays and failures in diagnosis showed that these were mainly due to the patient's delay in seeking or accepting advice, or inadequate investigation, particularly failure to examine the sputum, by the unofficial (non-governmental) medical services. The majority of failures in management were attributable in whole or in part to the patient.

Adolescent↗
PubMed1980

A study of the accuracy, and factors influencing accuracy, of home addresses of patients obtained by registry clerks and address cards in four large towns in South India.

In 4 large towns in South India with illiteracy levels of 26% to 40%, the efficiency of registry clerks in eliciting the home addresses of 1338 out-patients was assessed, by verifying receipt of a letter posted to the patients. The efficiency was found to be very poor, namely 66%. Moreover, the accuracy of address was substantially poorer for illiterate patients and for patients living for relatively short durations at their present address. Our innovation, the address card, on which the home address was recorded by a knowledgeable literate person of the patient's choice, was returned by 98% of the patients, and the addresses were found accurate in 84%; the findings were similar in the 4 towns and were unaffected by any patient characteristic. The substantially better results with the address card were found in both illiterate and literate patients. These findings establish the address card as a simple, inexpensive and efficient device for obtaining accurate addresses.

Adult↗
PubMed1979

The symptoms of newly diagnosed pulmonary tuberculosis and patients' attitudes to the disease and to its treatment in Hong Kong.

A questionnaire was applied by Government Health Visitors in Hong Kong to 201 consecutive patients with smear-positive, and 199 with smear-negative pulmonary tuberculosis who were attending one of the 7 full-time Government chest clinics for the first time on account of their current illness. Information was obtained about the symptoms of the disease and its diagnosis and management outside the Government service, and about patients' knowledge and attitudes towards the Government service. Among the 343 patients who sought treatment because of respiratory symptoms, the first symptom for the great majority (81 %) was cough, 15 % having sputum and 27 % haemoptysis as well. However, treatment was sought by only 15 % because of cough alone, compared with 40 % because of haemoptysis. Most patients (76 %) attended their first source of treatment or investigation within a month of the onset of symptoms, but some allowed long delays, and only 35 % attended a Government chest clinic within a month (whether this was the first source of treatment or not). The first source attended was a private practitioner for 53 % of the patients, another private medical establishment for 4 %, a Government chest clinic for only 11 % and another Government medical establishment for 17 %, 9 % went first to a herbalist and 5 % went to a drug store or treated themselves. The delays between the patients' first attendance at a source of treatment and their first attendance at a Government clinic were important, because outside the Government chest clinics only 49 % were investigated by chest radiograph and only 7 % by sputum bacteriology. Only 33 % were even suspected of having pulmonary tuberculosis, and many were correspondingly inadequately treated. The patients were, in general, ill informed about the Government chest clinic service; 52 % did not know, before their current illness, of the existence of the service, only 9 % knew that it was free, and only 12 % that it specialised in the management of tuberculosis. This study thus revealed a need to educate the public about the symptoms of tuberculosis, and about the possibility of their being investigated and treated, free, in a Government chest clinic.

Adolescent↗