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Biomedical subjects

D E Phillips

Publications and source records attributed to D E Phillips.

At least 55 records · Page 3Linked to original sources
PubMed1991

The health services utilisation of a general practice population.

OBJECTIVE: to establish a viable methodology for the linkage of patients information between general practice and the secondary health care sector. To demonstrate this by examining the activities and cost of health care to a general practice community. METHODS: the linkage of computerised records was achieved using a unique alpha numeric identifier (the National Master Patient Index number). Using this link all patient activities for one general practice were analysed. Consultations and their outcomes in terms of pathology and radiology requests, prescriptions, and referrals to other health care providers were recorded. Secondary care activities analysed were outpatient, inpatient, day care, and accident and emergency attendances. RESULTS: the study population of 3611 patients produced 15,453 contacts in general practice (4.3 contacts per person per annum) and 2804 contacts with the secondary care system (0.8 contacts per person per annum). The total government expenditure was $824,567 for general practice care and $1,410,198 for secondary care, ie, $2,234,765 in total or $619 per person. CONCLUSION: this methodology for information linkage provides the potential for comprehensive examination of publicly funded health care in both general practice and hospital settings, thereby promoting better coordinated and more rational planning of services.

Costs and Cost Analysis↗
PubMed1991

Tuberculosis among long term hospital residents: report of a recent outbreak.

Following the diagnosis of a case of miliary tuberculosis in a ward of 30 psychogeriatric patients, a further seven patients required treatment for active tuberculosis, and an additional four received prophylactic therapy. Tuberculosis contributed significantly to the deaths of three patients during the outbreak. This report highlights the particular risks of both reactivation and primary tuberculosis among geriatric patients receiving long term residential care. Late diagnosis contributed to the extent of the outbreak. Previous studies indicate that occult transmission of tuberculosis is relatively common in this group. An active policy of screening and prophylactic treatment is advised.

Aged↗
PubMed1991

Performance/outcome measures for area health board diabetes services.

OBJECT: to examine the validity of performance indicators nominated by the Department of Health for area health board diabetes services for 1990-91. METHODS: by examination of admission/discharge data for the Otago region for the years 1985-9, together with a survey of randomly chosen clinical notes to quantify errors in the admission/discharge database. RESULTS: of the proposed indicators, there is marked variation in statistical significance, primarily as a consequence of the often small number of numerator events and denominator populations involved. Further the rates and statistical significance vary markedly depending on the interpretation of the numerator events to be included. Diabetes as the principal diagnosis was correctly recorded in 100% of notes examined. Of these the clinical diagnosis was incorrectly described in the discharge summary in 2% of cases. In 46% of cases where diabetes should have been recorded as a subsidiary diagnosis, it was not. CONCLUSIONS: the potential exists for significant misinterpretation of these indicators with the proposed data sources. Using routinely collected data there are potentially more robust indicators applicable for use at an area health board level. Much work needs to be done if these indicators are to truly reflect all facets of the performance of a diabetes service.

Diabetes Mellitus↗
PubMed1991

Short- and long-term effects of combined pre- and postnatal ethanol exposure (three trimester equivalency) on the development of myelin and axons in rat optic nerve.

This study evaluated the effects of a combined gestational and 10 day postnatal alcohol exposure (human three trimester equivalency) on the development of myelin and axons in rat optic nerve. Rats were exposed during gestation via liquid diet, then their artificially reared pups were further exposed for 10 postnatal days via an ethanol-containing diet fed by gastrostomy. Control animals from pair-fed dams were artificially reared for 10 days on pair-fed isocaloric diets. Anesthetized animals were perfused with fixative on gestational days (G) 15 and 20 and postnatal days (P) 5, 10, 15, 20, and 90, then optic nerve tissues prepared for electron microscopy. Optic nerve cross-sectional areas were generally less from G20 through P90 in ethanol exposed animals. Counts of the number of myelinated nerve fibers per unit area and of the numbers of fibers in different stages of myelin development revealed that alcohol exposure caused a delay in myelin acquisition at 10 and 15 days that was compensated for at 20 and 90 days. Myelin thickness as a function of axon diameter was decreased in the alcohol exposed animals from 10 through 90 days, indicating a permanent reduction in the relative thickness of myelin. These results show that alcohol exposure for all of gestation and 10 postnatal days in the rat (human three trimester equivalency) causes a permanent reduction in myelin thickness along with a delay in myelin acquisition in the optic nerve. Such alterations in developing and adult myelin could help to explain some of the neurological and visual dysfunctions associated with developmental alcohol exposures.

Animals↗
PubMed1991

Interpretation of maxillary sinus radiographs in children.

Nasal symptoms are a frequent cause of referral to paediatric ENT clinics. It is the policy of our unit to view sinus radiographs without a report at the initial clinic attendance. This study demonstrates there is no statistically significant difference in the interpretation of the radiographs between two ENT surgeons and a radiologist although there was a tendency for the radiologist to have a greater specificity. This finding may have financial implications. In addition a clear sinus radiograph is shown to be a significant negative finding.

Adolescent↗
PubMed1990

Effects of postnatal ethanol exposure on glial cell development in rat optic nerve.

This study morphologically evaluated the effects of limited postnatal alcohol exposure on the development of glial cells in the rat optic nerve. Rat pups were artificially reared on Days 5-18 with a supplemented milk diet fed via a chronic gastrostomy tube. Experimental animals received 4% ethanol in their diet on Days 5-9, otherwise the experimental and control animals received identical diets. Optic nerve tissues were prepared for electron microscopy on Days 10, 16, 22, 29, and 90. There were fewer glial cells per cross section and the cross-sectional areas of optic nerves were smaller on Days 10 and 16 in the ethanol-exposed animals. The alcohol caused a delay in the maturation of oligodendroglial cells at 10 days as evidenced by decreases in the total number of oligodendroglia present and by a delay in the appearance of immature cells within the oligodendroglial lineage. All of these effects were compensated for at later ages. There was no evidence of alcohol-induced degeneration of glial cells or their organelles. Thus, postnatal alcohol exposure causes a delay in oligodendrocyte maturation but appears to have no long-term effects on the glial cell population of rat optic nerve.

Animals↗
PubMed1989

Effects of limited postnatal ethanol exposure on the development of myelin and nerve fibers in rat optic nerve.

This study was designed to morphologically evaluate the effects of limited postnatal alcohol exposure on the development of myelin and axons in the rat optic nerve. Rat pups were artificially reared on Days 5-18 with a supplemented milk diet fed via a chronic gastrostomy tube. Experimental animals received 4% ethanol in their diet on Days 5-9, otherwise the experimental and control animals received identical diets in identical volumes. Optic nerve tissues were prepared for electron microscopy on Days 10, 16, 22, 29, and 90. The cross-sectional areas of optic nerves were smaller, there were fewer myelinated nerve fibers per unit area, and the progress of myelination was slowed on Day 10 in the ethanol-exposed animals. All of these effects were compensated for at later times. The ratio of myelin thickness to axon diameter was similar in experimental and control animals, indicating that the interaction between axon size and myelin formation was not affected by alcohol. The general distribution of axon sizes was unaffected by ethanol except at 10 days when the largest fibers were smaller. There was no evidence of alcohol-induced degeneration of axons, myelin, or glial structures. Thus, alcohol exposure during myelin development causes a delay in myelin acquisition that is later compensated for.

Animals↗
PubMed1989

An unusual cause of stridor following anaesthesia requiring tracheostomy.

A 75-year-old woman underwent panendoscopy and excision of a neck "lump". After antagonism of residual neuromuscular block and extubation of the trachea, she developed recurrent upper airway obstruction and stridor, necessitating a permanent tracheostomy. The possibility of vagal nerve involvement or injury should always be considered during excision of neck lumps. Preoperative indirect, atraumatic laryngoscopy by experienced surgeons is essential, as are tracheal intubation and vigilant postoperative observation.

Aged↗
PubMed1989

Digital and mirror assessment of the adenoids at operation.

The size of an adenoid is generally considered to be a significant factor in the causation of Eustachian tube dysfunction and glue ear in children. We studied 120 consecutive cases of children undergoing adenoidectomy. Our aim was to assess the accuracy of the digital and mirror examinations in identifying adenoid size. Two surgeons of 1 and 2 years' experience in the speciality were found to have a statistically significant correlation between mirror examination and the amount of adenoid removed at operation. One surgeon of 4 years' experience was found to have a higher degree of correlation for both mirror and digital examinations.

Adenoids↗
PubMed1988

Down's syndrome with lingual tonsil hypertrophy producing sleep apnoea.

A 12-year-old girl is presented with Down's syndrome and lingual tonsillitis causing sleep apnoea. In order to overcome her sleep apnoea she adopted a functional sleeping posture. The sleep apnoea was successfully treated by a single staged lingual tonsillectomy without preliminary tracheostomy. A return to a normal sleeping posture occurred spontaneously in the early post-operative period.

Child↗
PubMed1987

Hearing loss among stroke patients.

Pure-tone hearing thresholds were measured by air conduction for 140 right hemiplegic and 103 left hemiplegic patients who had suffered a single stroke. Statistical and informal testing of the mean audiometric thresholds revealed that: (1) the ability of the aphasic patient to attend to and to perform the audiometric test was independent of the severity of the aphasic impairment; (2) aphasic patients did not suffer disproportionately greater hearing losses than did other right hemiplegic stroke patients; (3) no relation was apparent between the severity of the hearing loss and the test ear or side of hemiplegia after stroke; (4) the severity of high-frequency hearing loss among stroke patients was consistent with that found in the elderly male population at Framingham, MA (Moscicki, Elkins, Baum, and McNamara, Ear Hear 1985;6:184-90); and (5) the prevalence of hearing loss among the stroke patients was greater than that reported at Framingham, but was consistent with rates found among elderly nursing home residents.

Adult↗
PubMed1987

The nasopharynx and adenoid in children with glue ear compared with normal controls.

This study was designed to demonstrate whether any differences could be detected in the nasopharyngeal soft tissue size and postnasal space airway in children with glue ear compared with controls. Lateral cephalometric radiographs of 34 children with bilateral glue ear confirmed by paracentesis were compared with those of normal children matched for age and sex. There was no difference in the measurement of adenoid depth between the 2 groups. However, it was found that the palatal airway size was significantly smaller in children with bilateral glue ear than in normal children. Reduction in the palatal airway to 4 mm or less is found in most cases with bilateral glue ear, but only in 15% of normal controls.

Adenoids↗
PubMed1987

An electron microscopic study of endrin induced alterations in unmyelinated fibers of mouse sciatic nerve.

This study examined the ultrastructural alterations in peripheral nerve of adult mouse following repeated sublethal exposures to endrin, a toxic chlorinated hydrocarbon which produces symptoms indicative of neuromuscular dysfunction. Male mice were given 20 daily ip injections of endrin in sesame oil (0.2 ml) in doses that increased from 1.5 mg/kg on days 0-3, to 2.0 mg/kg on days 4-11, and to 4.0 mg/kg on days 12-19. Controls were given the same intraperitoneal volume of sesame oil without endrin. Animals were sacrificed by glutaraldehyde perfusion after 4, 7, 14, and 20 days of exposure and 14 and 92 days postinjection and sciatic nerve tissue was prepared for electron microscopy. Myelinated nerve fibers, myelin and associated Schwann cells from endrin exposed animals appeared similar to those of controls and normal animals. Various morphological alterations were observed in many unmyelinated axons from endrin exposed animals. Such alterations included swelling, dissolution of microtubules and neurofilaments, the presence of unusual numbers of axoplasmic vesicles, both scattered and in packets, and less often, extreme vacuolation. In those Schwann cells associated with damaged axons the cytoplasm and the adaxonal space frequently contained vesicles, often in packets invaginating the axolemma. The results of this study indicate that repeated subacute doses of endrin can produce morphological alterations in unmyelinated peripheral nerve fibers and their associated Schwann cells without apparent damage to myelinated nerve fibers. The results are discussed relative to other studies producing similar nerve damage and to the potential mechanisms responsible for such damage.

Animals↗
PubMed1985

Effects of the insecticide chlordecone on the ultrastructure of mouse skeletal muscle.

This study examined the ultrastructural alterations in skeletal muscle of adult mice exposed to subacute doses of the insecticide chlordecone. Mice were given eight daily intraperitoneal injections of chlordecone and were then sacrificed one, eight, and 28 days after the last exposure. Forelimb grip strength of the animals was recorded before, during, and after exposure but chlordecone caused no apparent effects. Morphological changes in skeletal muscle were primarily confined to mitochondria and to lipid and glycogen distribution. At one day post-treatment, some mitochondria were electron dense or contained only poorly defined cristae while other mitochondria had redundant layers of bounding membranes or contained aggregations of membrane in myelin-like configurations. Also, after chlordecone treatments, lipid and glycogen were no longer visible. By 8 days post-treatment, most evidence of mitochondrial damage was no longer present and lipid and glycogen were again apparent but in lesser concentrations than in controls. By 28 days post-treatment, the muscle was similar to controls except that lipid droplets were larger and more numerous. This study demonstrates that chlordecone, in subacute doses, produces reversible changes in skeletal muscle mitochondria and in glycogen and lipid stores but without altering muscle grip strength.

Animals↗