Biomedical subjects
B D Harrison
Publications and source records attributed to B D Harrison.
Comparison of the process of care of acute severe asthma in adults admitted to hospital before and 1 yr after the publication of national guidelines.
This study set out to assess the effect of publication of the British Guidelines on Asthma Management on the processes and outcomes of the inpatient care of acute severe asthma in the U.K. A criterion-based audit of all acute asthma admissions during August and September 1990 (immediately before) and in 1991 (1 yr after publication of the Guidelines) using eight criteria of process and outcome was performed. Thirty-six teaching and district general hospitals in England, Scotland and Wales took part. In total, 766 patients admitted in 1990, and 900 patients admitted in 1991, were studied. The 1990 and 1991 cohorts were very similar demographically and had asthma of comparable severity. Respiratory physicians achieved similar high performance rates of between 75 and 91% for seven of the eight criteria for both years. Respiratory physicians were significantly more likely to provide patients with a written management plan in 1991. General physicians' performance was significantly lower in both years, but overall there was a very small, but just significant, improvement in their performance in 1991. Some hospitals performed consistently well in both years. It is concluded that respiratory physicians consistently provide better asthma care than general physicians. Though statistically significant, the small degree of improvement was disappointing. Possible reasons include: insufficient time for the Guidelines to be incorporated into practice; inaccessibility of the Guidelines to general physicians; failure to accept responsibility for implementing the good practice reflected in the Guidelines; and an explicit need for strategies to implement the Guidelines beyond publication in a widely-read general medical journal.
Effect of a preprinted form on the management of acute asthma in an accident and emergency department.
OBJECTIVE: To assess the effect of a preprinted form on the documentation of clinical data and compliance with the national guidelines for the management of asthma. METHODS: Prospective audit six months before and after introduction of the form. RESULTS: Use of the form improved the documentation of past asthma history (69% v 93%, P < 0.001), current treatment (81% v 95%, P < 0.01), predicted peak flow (23% v 75%, P < 0.001), per cent predicted peak flow (1% v 62%, P < 0.001), and respiratory rate (81% v 95%, P = 0.007). Compliance with the British recommendations for treatment improved with use of the form (50% v 89%, P < 0.001) The prescription of steroids on discharge did not improve significantly (26% v 44%, P > 0.05). CONCLUSIONS: The preprinted form resulted in enhanced documentation of data and conformity with current guidelines for the management of asthma.
British Thoracic Society Sarcoidosis study: effects of long term corticosteroid treatment.
BACKGROUND: Corticosteroids suppress disease activity in pulmonary sarcoidosis and their use produces symptomatic, radiographic, and functional improvement. There is, however, uncertainty regarding their effects on the overall natural history of the condition and long term benefit is unproven. METHODS: Patients with pulmonary radiographic shadowing due to sarcoidosis were recruited in a multicentre study. Those who, in the first six months after entry to the study, neither required prednisolone for symptoms nor showed radiographic improvement were allocated at six months to receive either long term steroid treatment (group L) or selective treatment (group S), with regular assessment over the subsequent five years. Patients in group L were scheduled to receive steroid treatment for at least 18 months with the policy of achieving and maintaining maximal radiographic clearing, while in group S treatment was reserved for use only if warranted by later development of symptoms or deteriorating lung function. Symptoms, radiographic appearances, and respiratory function were assessed periodically during the study. RESULTS: One hundred and forty nine patients were followed: 33 required prednisolone for troublesome symptoms within six months of entry and 58 showed radiographic improvement over this period. The remaining 58 patients were allocated to groups L (n = 27) and S (n = 31). Patients in group L showed greater improvements in symptoms, respiratory function, and radiographic appearances than those in group S, although the differences were not large. After adjusting for differences at the time of allocation, the average difference in vital capacity between groups L and S at final assessment was 9% of the predicted value. Side effects of treatment were frequent but usually mild, necessitating withdrawal in only two individuals. CONCLUSIONS: After excluding those individuals who required steroids for control of symptoms, approximately half of the remaining patients with sarcoidosis and pulmonary shadowing showed spontaneous radiographic improvement during six months of observation. In those in whom the radiograph failed to improve, prolonged steroid treatment with the aim of optimising radiographic appearances resulted in a significantly better long term functional outcome.
A confidential enquiry into deaths caused by asthma in an English health region: implications for general practice.
AIM: To determine the factors contributing to death from asthma in patients aged under 65 years in East Anglia in the early 1990s. METHOD: We have performed on ongoing confidential enquiry since January 1992. For the first time a general practitioner was included in the enquiry team. RESULTS: A review of the clinical and pathological data of the 50 patients reported in the first 3 years suggested that 36 of these deaths were attributable to asthma. Thirty-one patients died out of hospital (3 en route to the hospital), 2 in the Accident and Emergency department, and only 3 in hospital. Adverse social factors were found in 25 out of 34 patients, and adverse psychological characteristics in 23 of the 31 patients where these could be assessed. Only 7 appeared to have no adverse psychological or social factors. Routine medical care was considered appropriate in 20 patients, and inappropriate in 14. Twenty-four had received appropriate advice and education. Nine of the 21 patients, where this could be assessed, and half the relatives, failed to respond appropriately to worsening asthma symptoms during the fatal attack. No potentially preventable factors were identified in two women who died of end stage asthma. CONCLUSION: This enquiry has demonstrated that inadequacies in the medical care of asthma continue to occur, although less frequently than in previous asthma-death studies. In addition, 79% of the patients had experienced psychosocial factors which appeared important in contributing to their deaths. Recommendations for identifying and managing such "at risk' patients have been circulated to all general practitioners and chest physicians in the region.
Fatal aplastic anaemia associated with lisinopril.
Explore the source record for details and available documents.
Consultants' workload in outpatient clinics. Quality of care has improved.
Explore the source record for details and available documents.
Sequence analysis and gene content of potato mop-top virus RNA 3: further evidence of heterogeneity in the genome organization of furoviruses.
The complete sequence of the 2315 nucleotides in RNA 3 of potato mop-top furovirus (PMTV) isolate T was obtained by analysis of cDNA clones and by direct RNA sequencing. The sequence contains an open reading frame for the coat protein (20K) terminated by an amber codon, followed by an in-phase coding region for an additional 47K. PMTV therefore resembles soil-borne wheat mosaic (SBWMV) and beet necrotic yellow vein (BNYVV) viruses (two other fungus-transmitted viruses with rod-shaped particles) in having a coat protein-readthrough product. Comparison of the 3' untranslated regions of PMTV RNA 2 and RNA 3 reveals a long conserved block of 150 nucleotides, which contains two repeated sequences and has the potential to form consecutive pseudoknot structures. PMTV RNA 3 ends a few nucleotides downstream of this conserved block, but RNA extends for a further 140 nucleotides, which can potentially form a 3'-terminal tRNA-like structure similar to those in the RNA species of SBWMV, tymoviruses, and some tobamoviruses. PMTV coat protein has amino acid sequence identities of 30 and 28% with SBWMV and BNYVV coat proteins, respectively, and apparent structural similarities with tobacco mosaic virus coat protein. The coat protein readthrough domains of PMTV, SBWMV, and BNYVV have shared residues throughout their length but no extended sequences are conserved. The presence in RNA 3 of coding sequences for only the coat protein and readthrough domain distinguishes PMTV from SBWMV and BNYVV, both of which have them in RNA 2 along with one or more other genes. Comparison of the genomes of PMTV, BNYVV, and SBWMV shows that furoviruses exhibit considerable heterogeneity in genome organization.
Nucleotide sequences from tomato leaf curl viruses from different countries: evidence for three geographically separate branches in evolution of the coat protein of whitefly-transmitted geminiviruses.
The coat protein (CP) gene-containing circular DNA molecule of an isolate of tomato leaf curl geminivirus (ITmLCV; 2749 nt) obtained from southern India, and the CP genes of tomato yellow leaf curl geminivirus isolates from Nigeria and two regions of Saudia Arabia were sequenced. ITmLCV DNA had the same arrangement of ORFs, and the same pattern of repeats in the large intergenic region as is found in in DNA-A of other whitefly-transmitted geminivirus (WTGs) from the Old World. However, the sequence of ITmLCV DNA and the sequences of its predicted translation products differed substantially from those of other WTGs, including one isolate obtained from a tomato plant in northern India. Comparison of the four CP sequences deduced here with those of 18 WTGs previously studied indicated that their relationships can be represented by a tree with three branches that are unrelated to plant host species but which contains viruses from the Americas, Africa to the Middle East, and Asia to Australia, respectively. It is suggested that WTG CP evolution has proceeded along different paths in these three main regions, and that WTGs have adapted freely to new hosts in each region. Indeed, the virus isolates causing similar diseases of tomato plants in the different continents are, with few exceptions, not closely related and warrant recognition as separate species.
National audit of acute severe asthma in adults admitted to hospital. Standards of Care Committee, British Thoracic Society.
OBJECTIVE: To ascertain the standard of care for hospital management of acute severe asthma in adults. DESIGN: Questionnaire based retrospective multicentre survey of case records. SETTING: 36 hospitals (12 teaching and 24 district general hospitals) across England, Wales, and Scotland. PATIENTS: All patients admitted with acute severe asthma between 1 August and 30 September 1990 immediately before publication of national guidelines for asthma management. MAIN MEASURES: Main recommendations of guidelines for hospital management of acute severe asthma as performed by respiratory and non-respiratory physicians. RESULTS: 766 patients (median age 41 (range 16-94) years) were studied; 465 (63%) were female and 448 (61%) had had previous admissions for asthma. Deficiencies were evident for each aspect of care studied, and respiratory physicians performed better than non-respiratory physicians. 429 (56%) patients had had their treatment increased in the two weeks preceding the admission but only 237 (31%) were prescribed oral steroids. Initially 661/766 (86%) patients had peak expiratory flow measured and recorded but only 534 (70%) ever had arterial blood gas tensions assessed. 65 (8%) patients received no steroid treatment in the first 24 hours after admission. Variability of peak expiratory flow was measured before discharge in 597/759 (78%) patients, of whom 334 (56%) achieved good control (variability < 25%). 47 (6%) patients were discharged without oral or inhaled steroids; 182/743 (24%) had no planned outpatient follow up and 114 failed to attend, leaving 447 (60%) seen in clinic within two months. Only 57/629 (8%) patients were recorded as having a written management plan. CONCLUSIONS: The hospital management of a significant minority of patients deviates from recommended national standards and some deviations are potentially serious. Overall, respiratory physicians provide significantly better care than non-respiratory physicians.
Arterial blood gas analysis or oxygen saturation in the assessment of acute asthma?
BACKGROUND: A study was undertaken to determine if arterial blood gas estimation is always necessary in the assessment of patients presenting to hospital with acute severe asthma, or whether oxygen saturation as measured by pulse oximetry is a reliable screening test for predicting those in respiratory failure. METHODS: A prospective study was conducted in a specialist respiratory medical unit. Arterial blood gas tensions and pulse oximetry were measured in 89 consecutive patients admitted with acute severe asthma. Respiratory failure was defined as PaO2 < 8.0 kPa or PaCO2 > 6 kPa. RESULTS: When oxygen saturation was 92% or higher (72 patients) respiratory failure was found in three (4.2%) cases. In the 82 patients with a saturation of 90% or higher six patients (7.3%) had respiratory failure. CONCLUSIONS: In the initial assessment of acute severe asthma an oxygen saturation of > 92% suggests that respiratory failure is unlikely and therefore arterial blood gas measurement is unnecessary. This study is only relevant to the assessment of asthmatic patients at presentation. Other parameters of severity must be continually assessed in all asthmatic patients admitted to hospital irrespective of the initial SaO2, and blood gases measured when clinically indicated.
Antigenic structure of the coat protein of potato mop-top furovirus.
The antigenic structure of the coat protein (CP) of potato mop-top furovirus (PMTV) was studied by electron microscopy of virus particles labeled with gold-conjugated monoclonal antibodies (MAbs) and by the reactions of MAbs with overlapping octapeptides (Pepscan) representing the complete amino acid sequence of the CP. A total of seven epitopes were identified in the CP. MAb SCR 69 detected a continuous epitope, which was located at the extreme N-terminus of the CP, was exposed at the surface along the sides of PMTV particles, and was removed by treating them with trypsin. MAb SCR 68 detected a discontinuous epitope found at the concave end of PMTV particles. Five other epitopes, which were detected by Pepscan tests, were located internally in, and at intervals along, the CP amino acid sequence. A tentative model of the PMTV CP subunit was produced, based on computer-aided prediction of its secondary structure and apparent similarities with the CP of tobacco mosaic virus. In this model, four of the epitopes occur at high radius in each of the pairs of parallel and anti-parallel alpha-helices in the CP subunit. The fifth is at low radius in the putative left radial alpha-helix. The epitope detected by MAb SCR 77, although amenable to study by Pepscan, contains three reactive elements, separated by short runs of nonessential residues, in a sequence of 13 amino acids. In intact virus particles, the CPs of beet necrotic yellow vein furovirus and PMTV apparently differ in the accessibility of their N- and C-termini.
A criterion based audit of community-acquired pneumonia.
UNLABELLED: We undertook a prospective audit of patients admitted to a specialist respiratory unit in order to assess: (a) the completeness of the objective assessment of severity of community-acquired pneumonia in patients on admission to hospital, and whether such indices were useful in predicting outcome; (b) the completeness of microbiological testing and whether maximizing the number of specimens sent to the laboratory would increase the frequency of positive microbiological diagnoses and; (c) the influence of the above on clinical management. Forty-eight patients with consolidation on chest X-ray were studied in two audit periods: 1 February 1991 to 1 May 1991 and 2 May 1991 to 16 March 1992. After the first audit period, a rubber stamp with a check list of microbiological investigations was used in the patients' notes. Seven 'markers of severity' of pneumonia, were recorded consistently throughout the study and these were useful in predicting outcome (P < 0.01). In the first audit period sputum culture, blood culture and acute serology were recorded in approximately 50% of patients. Following the introduction of the rubber stamp, the requesting of sputum, blood and urine antigen rose from none in the first audit period to 40-60%. The increase in the number of specimens obtained was not associated with an increase in the proportion of positive microbiological diagnoses. Clinical management was altered in 10 patients because of the microbiological reports and in four patients with negative microbiology (chi2 = 8.19; P < 0.01). CONCLUSION: The standard of initial assessment was high in this specialist unit, and the presence of two or more 'markers of severity' did help predict outcome. A simple change in work practice resulted in a significant improvement in the thoroughness of microbiological investigations.(ABSTRACT TRUNCATED AT 250 WORDS)
The nucleotide sequence of potato mop-top virus RNA 2: a novel type of genome organization for a furovirus.
Particles of isolate T of potato mop-top furovirus (PMTV) contain three RNA species (6.5, 3.0 and 2.5 kb). Hybridization tests with cloned cDNA probes showed that none of these species was derived from another. RNA 2 (2962 nt), which was sequenced, has non-coding regions of 368 nt and 285 nt at the 5' end and 3' end, respectively. Near the 5' terminus, nucleotides 46 to 110 are able to form a stem-loop structure, the stem of which has 23 bp with only one mismatch and one unpaired nucleotide. From the 5' end, the four open reading frames encode proteins of 51K, 13K, 21K and 8K. The first three of these have sequence similarity to the triple-gene-block proteins of other viruses, particularly barley stripe mosaic hordeivirus. The 51K protein contains a putative NTP-binding motif and the 13K and 21K proteins each contain two hydrophobic regions separated by a hydrophilic region. The 8K protein is rich in cysteine. PMTV differs from other furoviruses in having a tripartite genome. Its RNA 2 differs in gene content from the RNA 2 of soil-borne wheat mosaic virus, which lacks a triple gene block, and from that of beet necrotic yellow vein virus, which has a coat protein gene and read-through domain to the 5' side of its triple gene block. The gene arrangement in PMTV is therefore novel for a furovirus.
Systemic mastocytosis--a case treated with interferon alpha and radiotherapy.
Systemic mastocytosis is uncommon. Symptoms result from local infiltration and degranulation of mast cells. Reports in the literature describe successful use of interferon alpha and radiotherapy to produce reduction in symptoms and bulk of disease. We report a patient who responded to radiotherapy but not interferon alpha.
Value of pulsus paradoxus in assessing acute severe asthma. British Thoracic Society Standards of Care Committee.
Explore the source record for details and available documents.