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Biomedical subjects

A Macfarlane

Publications and source records attributed to A Macfarlane.

At least 73 records · Page 4Linked to original sources
PubMed1987

Immunisation of children by a nurse without a doctor present.

Over 16 months 148 children were referred by health visitors and general practitioners to a specially trained nurse for failing to complete courses of immunisation. A further 91 children of travellers' families were identified as needing immunisation. The nurse carried out 810 immunisations on 237 of these children in their homes without a doctor being present. There were only two refusals, and one child suffered a mild anaphylactic shock. The cost per immunisation, in nurse's salary and travel expenses, was pounds 8. This is an effective and fairly inexpensive way of achieving uptake of immunisation in such groups of children, and there seems no reason why trained nurses should not give immunisations either in a child health clinic or at home, without a doctor present.

Child↗
PubMed1987

Teenagers and their health.

Six hundred and forty three children aged 14 to 16, attending three upper schools in Oxfordshire, filled in a health questionnaire. Although over 90% rated their health as fair or good, three quarters had taken medicine in the previous four weeks, three quarters had complained of headaches, and three quarters had had dental fillings. In addition, a third drank alcohol at least once a week, a third felt depressed at least once a week, and a third had had time off school for illness in the previous four weeks. There were strong associations between smoking tobacco and other forms of drug abuse. On the positive side, most children felt responsible for their own health with three quarters agreeing that good health is mainly due to sensible living. Over 85% turned first to their parents for medical advice.

Adolescent↗
PubMed1986

Maintenance chemotherapy for anaplastic small cell carcinoma of the bronchus: a randomised, controlled trial.

Since March 1980, 309 patients with anaplastic small cell carcinoma of the bronchus (ASCB) have received remission induction therapy prior to randomisation to maintenance (M) or no maintenance (NM) chemotherapy. Induction therapy consisted of six courses of vincristine, doxorubicin and cyclophosphamide (VAC) given IV every 3 weeks. Those with limited disease also received mediastinal irradiation. Consenting patients with no unequivocal residual disease were randomised to have no further treatment until relapse or a further eight courses of VAC, at a lower dosage, every 4 weeks. Patients failing to achieve randomisation status received palliative treatment only. The median survival for all patients with limited disease (LD) is 363 days and that for patients with extensive disease (ED) is 272 days (P less than 0.00001). Sixty-one patients with ED were randomised. Those having maintenance chemotherapy lived significantly longer (median 372 days) than those who did not continue therapy (median 259 days) (P = 0.006). An imbalance in the proportion of 'complete remitters' randomised to maintenance therapy does not account for this difference. There is no significant difference between the M and NM groups in the 32 randomised LD patients. Continuing treatment during remission with agents used to induce the remission can prolong survival in patients with extensive stage ASCB.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

Comparisons of data from regional perinatal mortality surveys.

The standard format in which NHS regions are invited to submit data from their perinatal mortality surveys for comparative analysis in the British Journal of Obstetrics and Gynaecology is described. Some examples of the way these data can and will be used to compare regional differences in mortality patterns are given and possible future developments are discussed. Although the term perinatal mortality is used in the title, it is hoped that surveys will cover stillbirths and neonatal deaths and also, where possible, late fetal deaths of less than 28 weeks gestation.

Birth Weight↗
PubMed1984

Adverse outcome of pregnancy and the quality of obstetric care.

The case-control method was used to study the relation between four possibly preventable adverse outcomes of pregnancy and suboptimal antepartum and intrapartum obstetric care defined by clinical consensus. Fetuses whose deaths were ascribed to asphyxia or trauma, and babies born at term who had seizures within 48 h of delivery, were significantly more likely than controls to have received suboptimal care during pregnancy. Babies with seizures, as well as those with terminal apnoea, were also substantially more likely than controls to have been born after a failure to react appropriately to signs of severe fetal distress during labour. Most of the babies who received suboptimal obstetric care, however, did not have any of these adverse outcomes. In addition, most babies with these adverse outcomes had apparently received satisfactory obstetric care. No relation was detected between cerebral palsy and suboptimal obstetric care.

Adolescent↗
PubMed1984

Day of birth.

Explore the source record for details and available documents.

Delivery, Obstetric↗
PubMed1984

Home births in England and Wales, 1979: perinatal mortality according to intended place of delivery.

A survey was carried out of all 8856 births occurring at home in England and Wales in 1979. Of these births, 67% had been booked for delivery at home, 21% had been booked for delivery in hospital, 3% had not been booked, and for 9% the intended place of delivery was unknown. The perinatal mortality varied almost 50-fold according to the intended place of delivery, ranging from 4.1/1000 births in those booked for delivery at home to 196.6/1000 unbooked births. Deliveries that occurred at home but had been booked for a hospital consultant unit were associated with a perinatal mortality of 67.5/1000. Births that had been booked for delivery at home included the smallest proportion of babies of low birth weight: 2.5% weighed 2500 g or less compared with 18% of those booked for consultant units and 29% of those not booked. Within these low birthweight groups there were noticeable differences in perinatal mortality; births booked to occur at home had the lowest mortality and unbooked births had the highest. Perinatal mortality among babies who weighed more than 2500 g was generally low irrespective of the intended place of delivery; the only exception was in babies whose delivery had not been booked. In all groups perinatal mortality was considerably higher in nulliparous than parous women. Women booking a delivery at home are clearly a selected group, and some may have been transferred to hospital during labour and were thus not included in the survey. Nevertheless, these data suggest that the perinatal mortality among births booked to occur at home is low, especially for parous women.

Adult↗
PubMed1984

'A time to die'?

In both the newborn and the elderly, medical care is increasingly able to prolong or curtail life. It is difficult to assess what effect this may have on the population as a whole and what implication it may have for the interpretation of both short-term and longer-term changes in mortality. The definition of cut-off points for age groups is critical to the interpretation of the way changes in medical care could affect infant mortality rates.

Aged↗
PubMed1984

Bilateral primary choroidal melanoma.

A case of bilateral primary choroidal melanoma is described in a 51-year-old white male. Histological confirmation followed enucleation of the left eye and local excision in the right. A careful systemic evaluation failed to demonstrate any other primary or secondary melanomata. This case is the first bilateral primary choroidal melanoma reported in the United Kingdom and the first to be described in which histological confirmation was obtained as a result of local excision of one of the tumours.

Choroid↗