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B Beaumont

Publications and source records attributed to B Beaumont.

17 recordsLinked to original sources
PubMed2003

Is it possible and worth keeping track of deaths within general practice? Results of a 15 year observational study.

AIM: To assess the value of maintaining a death register in a general practice with particular reference to monitoring quality of care. DESIGN OF STUDY: Observational study. SETTING: Inner London general practice. METHOD: The practice maintained a manual death register, retained medical records of all deceased patients, and requested information on cause of death from health authorities and coroners for 15 years. MAIN OUTCOME MEASURES: Number and causes of deaths; 3 yearly age standardised death rates; proportion of deaths formally notified to the practice; place of death; source of cause of death information. RESULTS: During the study period 578 patients died. Practice age standardised death rates fell significantly from 35.59 to 27.12/1000. 498 (86.2%) deaths were formally notified to the practice, 392 within 7 days of death. Of 143 deaths reported to the coroner, only 45 coroners' reports were received. 360 (64.1%) died in hospital, 139 (24.8%) at home, and 38 (6.8%) in a hospice. Death certificate cause of death information was obtained from patients' records in 33.6% (n=194) of cases and from health authority sources for 50% (n=289). The pattern of ascertained causes of deaths was similar to the national pattern. CONCLUSION: A death register can examine trends in practice deaths by age and place of death and comparisons undertaken with nationally published mortality data. An accurate picture of cause of death cannot be generated from routine data flows alone. There is delay in informing GPs of patient deaths. Meaningful and timely monitoring of deaths cannot be undertaken by individual practices. National Statistics should provide routine analysis of GP death certificate information.

Adolescent↗
PubMed2001

Survey of injectable methadone prescribing in general practice in England and Wales.

Little is known about the extent and conduct of general practice prescribing of injectable methadone to opiate users in England and Wales. A postal questionnaire survey of general practitioners (GPs) was conducted in 1999 to ascertain how many GPs were prescribing injectable methadone, to describe their prescribing practices and to explore their perceptions of the service they provided. Four hundred and seven GP practices in 77 out of 105 health authorities were apparently prescribing injectable methadone. The difficulties in identifying, and obtaining a response from, GPs prescribing injectable methadone are discussed. Analysis of 93 usable returned questionnaires showed a range of GP characteristics and experience. The GPs were treating 211 patients with injectable methadone and a further 2003 patients with oral methadone. Prescribing practice and monitoring arrangements did not always follow national guidelines. A minority of GPs had received training in the management of drug dependency. They were most likely to decide to prescribe injectable treatment on the recommendation of a specialist drug agency, and to discontinue prescribing if there was a suspicion of diversion of prescribed ampoules. Although significant numbers of GPs felt unsure about their skills and the support available to them, most appeared to be managing their patients thoughtfully and with appropriate outcomes in mind. Recent policy documents from the Department of Health and the Home Office have questioned the place of injectable methadone in the treatment of opiate misuse, particularly in a general practice setting. A Home Office licence will shortly be required to prescribe injectable methadone. This survey suggests a minority of GPs would apply for such a licence. More research into the effectiveness of injectable methadone treatment in a range of settings is needed before conclusions can be drawn about the appropriateness of providing this treatment in general practice.

Journal Article↗
PubMed2001

Comparison of deposits of versican, biglycan and decorin in saphenous vein and internal thoracic, radial and coronary arteries: correlation to patency.

BACKGROUND: Matrix proteoglycans versican, biglycan and decorin are important determinants of vessel-wall structure and pathology. Thickened myxoid intimas typical of restenosis and early atherosclerosis are enriched in versican and biglycan, proteoglycans that promote proliferation and migration of smooth muscle cells and bind lipoproteins. In contrast, compact fibrous intimas are characterized by decorin. OBJECTIVE: To compare the distribution patterns of these matrix proteoglycans, and changes induced by organ culture in coronary artery, saphenous vein, internal thoracic artery (ITA), and radial artery, and correlate differences to patency. METHODS: Vessels were collected at the time of bypass surgery and heart transplantation and either fixed for immunohistochemistry or prepared for organ culture. Vessels in culture were labelled with [3H]-glucosamine and processed for autoradiography and immunohistochemistry. Distribution patterns for proteoglycans and radio-labelling were determined morphometrically. RESULTS: Distribution profiles in coronary artery and saphenous vein were similar, with relatively high levels of subendothelial versican and biglycan and low levels of decorin. In culture subendothelial incorporation of [3H]-glucosamine and immunostaining for versican and biglycan, but not decorin, were significantly increased. In contrast, the thin intima of the ITA was relatively enriched in decorin compared with the medial layers and in culture intimal staining for decorin increased markedly compared with a modest increase for biglycan and no change for versican. There was an even distribution in radial artery of all three proteoglycans across the intima without subendothelial accumulations. In culture there was an increase in staining intensity for proteoglycans of the radial artery. Neither the ITA nor radial artery exhibited an increase in subendothelial incorporation of [3H]-glucosamine in culture. CONCLUSIONS: The distributions of proteoglycans, and responses to culture correlate to the known differences in patency between grafted saphenous vein and ITA and predict that the radial artery will outperform the saphenous vein but might not be as good as the ITA for long-term patency.

Adult↗
PubMed1993

B-mode ultrasound images of the carotid artery wall: correlation of ultrasound with histological measurements.

B-mode ultrasound is being used to assess carotid atherosclerosis in epidemiological studies and clinical trials. Recently the interpretation of measurements made from ultrasound images has been questioned. This study examines the anatomical correlates of B-mode ultrasound of carotid arteries in vitro and in situ in cadavers. Twenty-seven segments of human carotid artery were collected at autopsy, pressure perfusion fixed in buffered 2.5% glutaraldehyde and 4% paraformaldehyde and imaged using an ATL UM-8 (10 MHz single crystal mechanical probe). Each artery was then frozen, sectioned and stained with van Gieson or elastin van Gieson. The thickness of the intima, media and adventitia were measured to an accuracy of 0.01 mm from histological sections using a calibrated eye graticule on a light microscope. Shrinkage artifact induced by histological preparation was determined to be 7.8%. Digitised ultrasound images of the artery wall were analysed off-line. The distance from the leading edge of the first interface (LE1) to the leading edge of the second interface (LE2) was measured using a dedicated programme. LE1-LE2 measurements were correlated against histological measurements corrected for shrinkage. Mean values for the far wall were: ultrasound LE1-LE2 (0.97 mm, S.D. 0.26), total wall thickness (1.05 mm, S.D. 0.37), adventitia (0.35 mm, S.D. 0.16), media (0.61 mm, S.D. 0.18), intima (0.09 mm, S.D. 0.13). Ultrasound measurements corresponded best with total wall thickness, rather than elastin or the intima-media complex. Excision of part of the intima plus media or removal of the adventitia resulted in a corresponding decrease in the LE1-LE2 distance of the B-mode image. Furthermore, increased wall thickness due to intimal atherosclerotic thickening correlated well with LE1-LE2 distance of the B-mode images. B-mode images obtained from the carotid arteries in situ in four cadavers also corresponded best with total wall thickness measured from histological sections and not with the thickness of the intima plus media. In conclusion, the LE1-LE2 distance measured on B-mode images of the carotid artery best represents total wall thickness of intima plus media plus adventitia and not intima plus media alone.

Adult↗
PubMed1992

Visual problems in the elderly population and implications for services.

OBJECTIVE: To determine the prevalence of visual disability and common eye disease among elderly people in inner London. DESIGN: Cross sectional random sample survey. SETTING: Inner London health centre. SUBJECTS: Random sample of people aged 65 and over taken from practice's computerised age-sex register. MAIN OUTCOME MEASURES: Presenting binocular Snellen 6 m distance acuity and best monocular 3 m Sonksen-Silver acuity to classify prevalence of blindness by World Health Organisation criteria (less than 3/60 in better eye) and American criteria for legal blindness (better eye equal to 6/60 or less) and of low vision by WHO criteria (best acuity 6/18) and visual impairment by American criteria (less than 6/12 or 20/40 but greater than 6/60 or 20/200 in better eye). Principal cause of visual loss by diagnosis, referral indication by cause to hospital eye service, and proportion of cases known to primary care. RESULTS: 207 of 288 (72%) eligible people were examined. 17 (8%) housebound subjects were examined at home. The prevalence of blindness was 1% by WHO criteria and 3.9% by American criteria. The prevalence of low vision (WHO criteria) was 7.7%. The prevalence of visual impairment (American criteria) was 10.6%. Cataract accounted for 75% of cases of low vision. Only eight out of 16 patients with low vision were known by their general practitioner to have an eye problem. 56 subjects (27%) would probably have benefited from refraction. Comparisons with studies in the United States and Finland suggested higher rates in this sample, mainly due to the prevalence of disabling cataract. CONCLUSION: There seems to be a considerable amount of undetected ocular disease in elderly people in the community.

Aged↗
PubMed1986

Changes in the morphology and synthetic activity of cultured rat tail tendon.

Isolated single fascicles from tail tendons of young rats were freed of epitenon cells and cultured in vitro for up to 7 days. The tissue remained viable, as judged by the structural integrity of cell organelles and the ability to synthesize DNA and glycosaminoglycans (GAG). The rate of DNA synthesis peaked after 2 days in culture and decreased slowly thereafter. Concomitantly, an increase in cell number was noted at the periphery of the fascicle. GAG production also increased during culture, sulphated GAG being increased proportionately more than hyaluronic acid. Dermatan sulphate was the predominant sulphated GAG in freshly isolated fascicles, but in cultured tissue, the newly synthesized sulphated GAG was more sensitive to degradation by chondroitinase AC and had an increased electrophoretic mobility. fine structural changes were observed in cultured tissues such as the retraction of cell processes. rounding up of cell bodies and the appearance of gaps between collagen fibrils. Cultured tenocytes also frequently contained apparently phagocytized collagen fibrils which were not seen in freshly isolated fascicles, and this appearance was suggestive of collagen degradation occurring in vitro, although no change in the total hydroxyproline content was noted. The data show that when individual fascicles are cultured in vitro they undergo a process of matrix remodelling which has features in common with events occurring in vivo when tendons have been surgically manipulated.

Animals↗
PubMed1979

Special provisions for women doctors to train and practise in medicine after graduation: a report of a survey.

The findings of a survey of 3262 women doctors registered between 1945 and 1974 are reported. The results are based on 2433 returned questionnaires (75% response). The survey confirmed that the special forms of assistance provided to enable women doctors to continue training and to work after graduation are inadequate. Although the Women Doctors' Retainer Scheme and part-time training schemes are suited to women's needs, they are insufficiently publicized, inflexibly administered and limited in availability. The need for a counselling service for women doctors is not met. Facilities for child care on NHS premises are very deficient. With more substantial provision of all these forms of assistance to women doctors, the scope and extent of their contribution to medicine could be increased. The Medical Register is an unreliable means of ascertaining the numbers and whereabouts of women who may require this special assistance. The main problem now is not a lack of ideas about suitable provision for women doctors, but the implementation by the relevant authorities of the proposals already made, to enable both women doctors themselves and the NHS to benefit.

Career Mobility↗
PubMed1979

Highland and lowland populations of Lesotho.

It has not been possible to demonstrate significant sero-genetic differences between lowland and highland Sotho populations; the differences which do exist may well be attributable to random genetic drift. The study shows that the Sotho have received an appreciable genetic contribution from the San they have absorbed but their sero-genetic profile remains eminently Negro. A low frequency of the PTC non-taster allele was found (t = 0.142 +/- 0.029) as was the overall frequency for colour blindness (cb = 0.013 +/- 0.009).

Alleles↗
PubMedDate not supplied

Effect of TGF-beta(1) antisense S-oligonucleotide on synthesis and accumulation of matrix proteoglycans in balloon catheter-injured neointima of rabbit carotid arteries.

Arterial matrix proteoglycans (PG) are necessary for the maintenance of viscoelastic properties of the vessel wall, but excess levels, particularly of versican and biglycan in primary and restenotic intimal thickenings, are correlated with increased tissue volume and with atherogenicity. There is good evidence that the primary stimulus to increased PG synthesis, including versican and biglycan, is transforming growth factor-beta(1) (TGF-beta(1)). The aim of this study was to determine the effects of reducing endogenous TGF-beta(1) on rates and patterns of PG synthesis and on versican, biglycan and decorin accumulation in vivo. Rabbit common carotid arteries subjected to balloon catheter injury were treated with a TGF-beta(1) antisense phosphorothioate oligonucleotide applied in a pluronic gel to the adventitia. Control animals received a nonsense oligonucleotide or gel alone. TGF-beta(1) antisense (1) significantly (p < 0.005) inhibited, at day 2, the balloon catheter-induced increase in TGF-beta(1) mRNA relative to beta-actin mRNA; (2) inhibited intimal thickening at 23 days by approximately 40% (p < 0.05); (3) inhibited (p < 0.05) PG synthesis, measured by autoradiographic detection of [(3)H]glucosamine, in the media of day 2 ballooned carotids and in the subendothelial zone of day 23 neointima, and (4) decreased immunostaining intensity for versican (p < 0.03) and TGF-beta(1) (p < 0.001) in the neointima. Biglycan was reduced to a lesser extent but not significantly and decorin was not affected. Proliferating cell nuclear antigen indices were variable and not significantly changed. These findings confirm a role for TGF-beta(1) in developing neointima and demonstrate a specific effect on the synthesis, distribution, and accumulation of matrix PG, particularly versican.

Animals↗
PubMedDate not supplied

Structural heterogeneity of the diffuse intimal thickening and correlation with distribution of TGF-beta 1.

This study examines the ultrastructural features of diffuse intimal thickenings of human coronary arteries and correlates structural heterogeneity along the radial axis with the distribution and known actions of transforming growth factor beta 1 (TGF-beta 1). Morphometric and immunohistochemical data were collected from thickenings of varying widths, sampled at autopsy from 19 persons ranging in age from 3 months to 81 years. Thickenings were characterised by an inner proteoglycan layer (PGL), up to approximately 70 mm wide, and an underlying variable-width musculofibrous layer (MFL). The PGL was characterised by low volume fractions (v/fs) for collagen, elastin, basement membranes and cells and a high v/f for matrix space; v/fs for the MFL components were more evenly distributed. Proteoglycans were visualised by ruthenium red staining, quantified and sized. Densities of large (versican; > 20 nm) and small (< 20 nm) granules changed little across intimal thickenings. Mean diameters of matrix space granules increased with increasing intimal thickness and notably were significantly (p < 0.001) larger in the PGL than the MFL. In contrast, diameters of collagen-associated small granules (decorin) did not differ between the PGL and MFL. TGF-beta 1 staining was detected in 70% of vessels examined and occurred almost exclusively in the PGL, although showed a patchy distribution. Both the distribution of TGF-beta 1 and its known differential effects on versican and decorin synthesis suggest that it may play a significant role in the formation and maintenance of the PGL.

Adolescent↗