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C D Sheldon

Publications and source records attributed to C D Sheldon.

At least 19 recordsLinked to original sources
PubMed1996

The Scottish Royal Colleges: a prospective survey of continuing medical education undertaken by their examiners.

OBJECTIVE: To measure the amount and nature of Continuing Medical Education (CME) activity undertaken by the examiners of the three Scottish Royal Colleges. The data obtained to be compared with recommendations for formal CME participation published by the medical Royal Colleges and Faculties. DESIGN: All examiners in active clinical practice prospectively surveyed over a 12 month period by completing a monthly return from a specially designed loose-leaf diary. RESULTS: 75% of the examiners who submitted all 12 monthly diary pages completed at least 100 hours CME during the year while 95% achieved 50 hours or more. This time was distributed approximately equally between hospital-based activities and activities for which study leave might have been taken. Although the mean total number of hours of CME undertaken by consultants based in district general hospitals was also over 100 hours in the year, this was significantly lower than the figure for teaching hospital consultants. The type of CME activity was described as general (16%), specialty (49%) and subspecialty (35%). The examiners surveyed found that specialist society and international specialist meetings were perceived to be the most valuable of those attended. CONCLUSIONS: The current recommendations for implementing formal CME systems for consultants are in line with the current activity levels of this group and should safeguard existing educational activity rather than impose new standards. This study suggests that the profession should not be unduly anxious about the introduction of a structured CME system although it is likely that some form of obligatory scheme will be required to achieve a more uniform response.

Education, Medical, Continuing↗
PubMed1994

Characteristics of patients with drug resistant and drug sensitive tuberculosis in East London between 1984 and 1992.

BACKGROUND: The aim of this study was to investigate retrospectively factors associated with drug resistant tuberculosis at the London Chest Hospital. METHODS: The microbiology results for patients with tuberculosis at the hospital for the period 1984-92 were reviewed, together with case notes and chest radiographs of all patients with drug resistant tuberculosis and of 101 patients with drug sensitive tuberculosis notified during the same period as a control group. RESULTS: Culture positive pulmonary tuberculosis occurred in 292 patients. Drug resistant strains were isolated from 20 patients (6.8%). Ten of the 292 (3.4%) had strains resistant to a single drug and nine (3.1%) had resistance to more than one first line drug. One patient had strains resistant to isoniazid and capreomycin. Strains resistant to more than one drug were all resistant to isoniazid and rifampicin. In five patients these strains were also resistant to pyrazinamide and in two they were resistant to streptomycin. Single drug resistant strains were resistant to isoniazid (nine patients) or streptomycin (one patient). Among the risk factors studied previous treatment for tuberculosis was the most significant association with drug resistant tuberculosis (7/9) for patients with resistance to more than one drug; 5/11 for single drug resistance compared with 6/101 patients in the drug sensitive group (odds ratio 22.8). Other risk factors were bilateral disease at presentation (odds ratio 8.5), and disease at a young age (odds ratio 1.03). CONCLUSIONS: Previous treatment for tuberculosis and bilateral disease at presentation were found to be more commonly associated with cases of drug resistant than with drug sensitive tuberculosis.

Adolescent↗
PubMed1993

Thoracoscopy.

Explore the source record for details and available documents.

Humans↗
PubMed1993

Incidence of abdominal tuberculosis in Bangladeshi migrants in east London.

A retrospective epidemiological study of abdominal tuberculosis in a defined population in the London Borough of Tower Hamlets was conducted between January 1985 and 31 December 1989. The total population of 163,900 included a mean of 20,732 Bangladeshis. Of the 13 cases diagnosed 8 were Bangladeshi, with equal involvement of the peritoneum and intestine. The crude incidence in the Bangladeshi community was 7.7 cases/10(5)/year, which was significantly higher than that in Europeans (0.3 cases/10(5)/year, chi 2 with Yate's correction = 14.0 P < 0.001). The highest age-specific incidence was amongst those aged 16-20 years and 41-45 years. Most patients had a laparotomy or peritoneal biopsy to confirm the diagnosis. The response to therapy was good. Only 62% of cases were notified. This study confirms the importance of tuberculosis in the differential diagnosis of abdominal symptoms in Bangladeshi patients.

Adolescent↗
PubMed1993

Regular three monthly oral ciprofloxacin in adult cystic fibrosis patients infected with Pseudomonas aeruginosa.

In 31 adult patients with cystic fibrosis (CF) who were chronically infected with Pseudomonas aeruginosa we examined the effect of giving regular three monthly oral ciprofloxacin. Patients received ciprofloxacin or placebo for 10 days every 3 months for 1 yr in a randomized, double-blind, placebo-controlled study. During each course of treatment patients receiving ciprofloxacin reported an improvement in cough, sputum production and peak expiratory flow (PEF) P = < 0.005. During the year of study patients receiving ciprofloxacin showed an improvement in PEF when compared with those receiving placebo (P = < 0.05) but the changes in FEV1 and FVC were not statistically different in either group. Regular oral ciprofloxacin was well tolerated but did not prevent hospital admissions or reduce the number of courses of intravenous antibiotics throughout the year. The median MIC to ciprofloxacin in the active treatment group rose from 0.5 mg l-1 to 0.75 mg l-1 during treatment. We conclude that CF patients are likely to benefit from oral ciprofloxacin for exacerbations of respiratory symptoms. However, regular treatment with ciprofloxacin over 1 yr improves PEF but does not reduce the rate of hospital admissions with acute exacerbations of respiratory symptoms.

Administration, Oral↗
PubMed1993

A cohort study of cystic fibrosis and malignancy.

A cohort of 412 patients first attending a cystic fibrosis (CF) clinic between 1961 and 1989 were followed up to 30 June 1989. The number of malignancies observed in the cohort was compared with the number expected based on the age, sex and calendar-year-specific cancer registration rates for England and Wales. Four CF patients were diagnosed as having malignancies before 30 June 1989. The tumours were: adenocarcinoma of the terminal ileum; adenocarcinoma of the pancreas, testicular teratoma, and B-cell lymphoma. This compares with 0.89 malignancies expected on the basis of rates in England and Wales (Standardised Registration Ratio = 452; 95% confidence interval 122-1150, P = 0.03). The single case of adenocarcinoma of the terminal ileum contrasts with less than 0.001 expected (P = 0.003) and that of the pancreas with 0.007 expected (P = 0.01). A further adenocarcinoma of the pancreas was diagnosed 2 years after the end of the study period. The two cases of pancreatic cancer compare with 0.008 expected (P = 0.0001) during the period to mid 1991. On the basis of the present findings and previous case reports in the literature adenocarcinoma of the pancreas and adenocarcinoma of the terminal ileum may be associated with cystic fibrosis.

Adenocarcinoma↗
PubMed1992

Notification of tuberculosis: how many cases are never reported?

BACKGROUND: Notification of tuberculosis is essential for local contact tracing and for assessing the national incidence of tuberculosis. The accuracy of notification figures is uncertain. This study examined the notification rates of all patients diagnosed as having tuberculosis at two hospitals in the East End of London over five years. METHODS: In a retrospective survey of all patients aged 16 years or more presenting with tuberculosis to the London Chest Hospital or the Royal London Hospital from 1 January 1985 to 31 December 1989, cases of tuberculosis were identified from microbiology and histology records, statutory notifications, necropsy reports, coroners' records, hospital activity data, and death certificates. Clinical data were obtained from case notes and notification was determined from the local authority notification lists. RESULTS: Six hundred and nine adult patients with tuberculosis were identified. Notes were available for 580 cases (95%), of which 426 (73%) had been notified. The proportion of cases notified varied according to the specialty of the clinician in charge of the patient at diagnosis. Patients with a past history of tuberculosis and those who died within one year were less likely to have had their tuberculosis notified. Age, race, and lack of microbial or histological confirmation of diagnosis did not influence the proportion of cases notified. One hundred and eighty five patients had smear positive sputum, but 25 of these cases (14%) were not notified. Eighty five patients who had presented with pulmonary tuberculosis did not have their disease notified; 20 (24%) had smear positive sputum. CONCLUSIONS: Many cases of tuberculosis are not notified (27%). Fourteen per cent of all sputum smear positive cases of tuberculosis were not notified, and these patients are a considerable public health risk. The true incidence of tuberculosis in the area studied is at least one third higher than current notification figures suggest.

Adolescent↗
PubMed1991

Umbilical artery flow velocity waveforms during spinal anesthesia.

The umbilical artery Doppler flow velocity waveform was recorded during spinal anaesthesia prior to elective caesarean section in 15 uncomplicated pregnancies. Although spinal anaesthesia was associated with a significant fall in maternal systolic and diastolic blood pressure, there was no change in the umbilical artery Pulsatility Index either after preloading the maternal circulation with 750-1000 ml of Hartman's solution or for the first 15 min after subarachnoid injection of 0.5% bupivacaine. The fetal heart rate fell after preloading the maternal circulation, but was unchanged by the administration of bupivacaine. There was a weak negative correlation between fetal heart and the umbilical artery Pulsatility Index. These observations suggest that in normal pregnancy, spinal anaesthesia has no detrimental effect on the umbilical artery Pulsatility Index.

Anesthesia, Epidural↗
PubMed1989

Umbilical artery flow velocity waveforms in labour.

Doppler signals were recorded from the umbilical arteries in 103 women during labour. The pulsatility index (PI) did not alter with progress in labour. During uterine contractions the PI showed a change only if there was a deceleration in the fetal heart rate. Low birthweight (less than 10th centile) and delivery by caesarean section for fetal distress were significantly more frequent in patients with abnormal PI values (defined as greater than 2 SD above the mean in normal labours). Fetal scalp blood pH was measured in 24 patients. The PI was abnormal in only one case, but none of the 24 had a pH less than 7.20.

Blood Flow Velocity↗
PubMed1988

Trial of ganglioside GM1 in acute stroke.

Ganglioside GM1 (100 mg) was given daily by intramuscular injection for 28 days in a double-blind placebo controlled trial of acute stroke. No significant difference was detected in a 6 month follow-up period between well matched control and active groups. Although the number of patients studied was small the findings are believed to indicate that GM1 is unlikely to be of value in the treatment of acute stroke in the dose and route of administration used.

Adult↗
PubMed1988

Thoracoscopy: assessment of a physician service and comparison of a flexible bronchoscope used as a thoracoscope with a rigid thoracoscope.

The practicality of physicians performing thoracoscopy for diagnostic purposes was assessed in 30 patients with pleural effusions of unknown cause. A rigid thoracoscope was compared with a fibreoptic bronchoscope used as a flexible thoracoscope and the diagnostic adequacy of biopsy specimens obtained with the two instruments assessed. The two instruments were inserted by a physician in the bronchoscopy suite using local anaesthesia. The procedure proved safe, acceptable, and diagnostically effective. The rigid thoracoscope proved a more satisfactory instrument but the fibreoptic bronchoscope, with minor adaptations, may be used for thoracoscopy.

Biopsy↗
PubMed1986

Doppler ultrasound in the estimation of the severity of pulmonary infundibular stenosis in infants and children.

Pressure gradients estimated by Doppler echocardiography were compared with values obtained at cardiac catheterisation in 31 children (aged seven days to 16 years, mean 2 years 7 months) with pulmonary infundibular stenosis including 16 with tetralogy of Fallot. Various parasternal and subcostal positions were explored to obtain the maximum velocity of blood flow and the obstructive gradient was calculated from the modified Bernoulli formula. The gradient across the obstruction could be measured directly at the time of catheterisation in only 21 patients. The correlation coefficient for the Doppler and total measured gradients was r = 0.90 for catheter entry and r = 0.77 for catheter withdrawal. Doppler ultrasound, by measuring the total gradient from the right ventricle to the pulmonary artery, provides a non-invasive assessment of the severity of pulmonary stenosis, and in those with infundibular obstruction allowance need not be made for possible energy losses caused by the elongated obstruction or the presence of narrowing at more than one level.

Adolescent↗
PubMed1985

The severity of pulmonary valve or artery obstruction in children estimated by Doppler ultrasound.

Doppler echocardiographic estimation of pressure gradient has been compared to that measured at cardiac catheterisation in 37 children, 6 weeks to 15 years of age, with suspected pulmonary valve stenosis or a pulmonary artery band. Various parasternal and subcostal positions were explored to obtain the maximum velocity of blood flow and the valve gradient was calculated from the modified Bernoulli formula. The Doppler study was performed at the time of catheterisation in 19, the maximum velocity being measured during catheter withdrawal in 7, immediately after withdrawal in 7, and while simultaneous right ventricular and pulmonary arterial pressures were measured in 5. Five other patients were studied within 24 hours of catheterisation and the other 13 within 6 months. Comparison of Doppler and catheterisation gradients showed a close correlation, this being particularly good where simultaneous right ventricular and pulmonary arterial pressures were measured. Doppler now provides an accurate non-invasive measurement of the severity of pulmonary valve stenosis and the adequacy of a pulmonary artery band.

Adolescent↗