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Biomedical subjects

A Currie

Publications and source records attributed to A Currie.

6 recordsLinked to original sources
PubMed1990

Evaluation of the need for follow-up in an out-patient clinic.

We have identified 164 patients regularly attending a chest clinic whose condition had been defined as stable on the basis of clear-cut criteria. These patients were randomly allocated to either routine follow-up at 3 monthly intervals (the 'follow-up' group) or annual follow-up (the 'discharge' group). After 1 year, on the basis of a questionnaire sent to the patients' general practitioners, there were no significant differences in outcome between the two groups apart from a just-significant increase in deaths in the 'follow-up' group. Nevertheless, at the conclusion of the trial clinic doctors felt that only 45% of patients and general practitioners that only 27% of patients should be discharged from the clinic. At the conclusion of the study patients in the 'discharge' group were significantly more likely to feel that they had been attending too infrequently and that their condition had worsened, although the latter was not borne out by objective data. We suggest that all these patients could have been discharged from the clinic without any difference in outcome. This study highlights the reluctance of clinic doctors and general practitioners to consider and effect the discharge of stable patients from routine clinic attendance.

Ambulatory Care Facilities↗
PubMed1989

Do chest physicians follow-up too many patients?

We have examined the pattern of attendance of 750 randomly selected regular attenders at a chest outpatient clinic and sought the patients' views on the frequency of their follow-up appointments and the possible consequences of discharge to the care of the general practitioners. In addition, the clinic doctors and the patients' general practitioners were asked about the appropriateness of the frequency of follow-up and whether the pattern of attendance should change or the patient be discharged. Patients were most commonly seen at three monthly intervals. Clinic doctors felt that 24% and general practitioners that 9% of patients attended too often while only 2% of patients felt that this was the case. Clinic doctors recommended discharge for 28% and general practitioners for 21% of patients. Sixty-nine per cent of patients felt that their condition would be unchanged or would improve if they were discharged to the care of their general practitioners. Our findings suggest that at least 20% of our patients should be discharged to the care of their general practitioners, and, if the patients are correct in their interpretation of the consequences of discharge, that as many as 70% could safely be discharged.

Adolescent↗
PubMed1986

Bile acids and the intestinal kallikrein-kinin system.

We have measured concentrations of tissue kallikrein-like amidase (TKLA) in blood-free rat gastrointestinal tissue. TKLA was present in the gut wall from the stomach to the rectum with concentration peaks in the duodenum and caecum. When rats, fasted for 24 hr were compared with normally fed animals, the mean fasted TKLA levels rose significantly in the duodenum and proximal and distal colons and fell in the caecum. No other tissues showed concentration changes. Sodium chenodeoxycholate and other bile acids have biological actions on the rat intestinal wall which are similar to those produced by the kallikrein-kinin system. We have previously reported that bile acids released TKLA from the rat colon wall. This TKLA was totally inhibited by aprotinin. We now report that intraluminal sodium chenodeoxycholate (30 mM) increases both colonic motility and colonic mucosal leakage. These increases are largely blocked by aprotinin. The ability of intraluminal sodium taurochenodeoxycholate to increase vascular leakage in the rat stomach and colon was parallelled by its ability to release TKLA from these issues. Our results are compatible with the mediation of these biological actions of the tested bile acids via activation of a serine proteinase, possibly tissue kallikrein.

Animals↗