Search PubMed⌕ Search

Biomedical subjects

D Gorman

Publications and source records attributed to D Gorman.

At least 73 records · Page 4Linked to original sources
PubMed1993

An observational study of car occupant restraint in Fife: impact of recent legislation.

During August 1992 an observational study of car occupant restraint use was carried out at 14 sites throughout Fife (representing traffic-signal-controlled junctions in rural and non-rural sites and observations made outside primary schools). This study replicated another completed in April 1991 before the most recent legislation on rear seat restraints. The overall restraint use found at the traffic signal sites (excluding taxis) was 87% (drivers 94%, front seat passengers 93% and rear seat passengers 59%). There was lower restraint use (68%) in cars taking children to and from primary schools (drivers 87%, front seat passengers 77% and rear seat passengers 50%). Passengers seated in rear centre seats were least likely to be restrained (40%) especially where they were an older child or adult (only 14% of this latter group being restrained). Restraint use in taxi cabs was low (drivers 11%, passengers 41%). Since rear seat legislation was introduced in July 1991 there has been a 77% increase in rear seat restraint use, especially in older children and adults (233% increase) and in 1-4-year-old children (119% increase); it is likely that these improvements are largely as a result of the legislation. However, approximately 40% of rear seat passengers still travel without rear seat belt restraint. There is therefore a continuing need to emphasise both public education and the enforcement of current legislation. Educational measures should be targeted at groups known to be low users such as drivers and passengers in taxis, children carried on school 'delivery trips' and adults in rear seats.

Adolescent↗
PubMed1993

Measles outbreak in Fife: which MMR policy?

The introduction of measles, mumps and rubella vaccine (MMR) into the United Kingdom childhood immunisation schedule has resulted in a substantial reduction in the incidence of all three diseases. None the less, there have recently been outbreaks of measles in parts of the country which have a record of high MMR uptake among young children. In these outbreaks it is mainly older children who have been affected. This report documents such an outbreak in Fife, an area with a very high MMR uptake among two-year-old children (96%). The current policy of giving MMR vaccine only once to children at 15 months of age may not be sufficient to enable the United Kingdom to achieve the WHO target of measles elimination by the year 2000. Other possible strategies to achieve this objective are discussed.

Adolescent↗
PubMed1993

An evaluation of a logbook for trainees in accident & emergency medicine in the United Kingdom: senior consultant opinion.

A previous paper from the Merseyside Group of Senior Registrars in Accident & Emergency Medicine examined the desirability of a logbook for Higher Specialist Training (HST) in accident & emergency medicine in the United Kingdom and its principal ingredients (Luke et al., 1991). A survey of 100 senior registrars and recently appointed consultants in the specialty identified the main issues of importance to the majority of respondents e.g. certification in advanced cardiac and trauma life support, a minimum of three years in the specialty before appointment as senior registrar and certain key secondments. In this paper, more senior consultants in the specialty were surveyed and a resounding majority concurred with the preferences of their junior colleagues. The findings are discussed and the implications for a future curriculum for postgraduate training in A&E medicine are explored.

Attitude of Health Personnel↗
PubMed1993

Evaluating the breast screening programme: the need for surgical audit.

It is to be anticipated that a reduction in population mortality attributable to mammographic screening would be heralded by an increasing proportion of breast cancer cases diagnosed at earlier stages and by an improvement in case fatality. Few cancer registers routinely produce incidence or survival data by stage at diagnosis and thus improvement in these will be the harder to assess. By thorough casenote review and follow up, this study has determined the usual presentation and survival of breast cancer in Northern Ireland in 1986 before the introduction of screening. Overall, 85% of cases were Manchester stage I or II, figures which accord with other British studies. Five-year survival ranged from 77.8% for stage I (95% confidence limits 71.7%, 82.7%) to 35.7% for stage IV (95% confidence limits 13.0%, 59.4%). Forty-three per cent of cases treated in non-teaching hospitals could not be pathologically staged, more than twice the figure for teaching hospitals (Chi-squared = 15.7, df = 1, P < 0.001). Since many tumours not detected by screening will be treated outside teaching centres, this difference will reduce the statistical power to detect the true shift in stage distribution and improvement in survival from screening. Comprehensive surgical audit would help to resolve the inadequacies in existing data collection and improve the ability to evaluate the outcome of the screening programme.

Adult↗
PubMed1992

Confidence intervals and interval cancers ... needles and haystacks?

The measurement of interval cancer rates will be critical to the successful evaluation of the breast cancer screening programme. The number of interval cancers expected in a district will depend on the population size, the test sensitivity and the background incidence of breast cancer. The present study was undertaken to measure the incidence of breast cancer in Northern Ireland, and to assess the practical problems that might be encountered in ascertaining interval cancers. Given a local yearly incidence of 182/100,000, only 14 interval cancers per year might be expected in Northern Ireland (population 1.5 million). The completeness of the local cancer register would not ensure reliable detection of this relatively small number of tumours. To give larger samples sizes and thus narrow the confidence intervals of measured rates, the results from several smaller regions could be aggregated. Different regions may have different mechanisms of ascertainment and this may make the interpretation of these rates more difficult.

Adult↗
PubMed1992

The dependent elderly: a comparative survey of institutional care in Fife.

Dependency levels were assessed in 441 elderly people in long term geriatric hospital care, 488 living in private nursing homes and 637 in the local authority residential homes in Fife. Results indicated that the most dependent were in hospital care, the most able in residential homes with private nursing homes accommodating elderly people with intermediate dependency levels. While each care setting cares for severely dependent elderly people, up to 29% of those in residential homes, 24% of those in nursing homes and 6% of hospital residents were considered by care staff to be fully independent. The implications of this in relation to the future provision and pattern of long term care for the frail elderly in Fife are considerable.

Activities of Daily Living↗
PubMed1992

Urinary incontinence: a survey of knowledge, working practice and training needs of nursing staff in Fife.

Urinary incontinence results in substantial morbidity within society and presents a serious public health problem. Improvements in the well being of incontinence sufferers can be achieved by appropriately trained nursing staff. As part of the development of a strategy to tackle the problem of incontinence in Fife, a survey of nursing staff working in the Board's three health care units was carried out. Response rates between 64% and 100% were achieved among the different units. The results of the survey have revealed a number of deficiencies in current nursing practice, with a substantial proportion of nursing staff indicating a desire for more training in aspects of the management of incontinence. Health visitors in particular reported a significant lack of training in the area of childhood enuresis.

Education, Nursing↗
PubMed1991

An evaluation of a logbook for trainees in accident and emergency medicine in the United Kingdom.

The ideal requirements of a logbook for trainees in accident and emergency medicine in the United Kingdom were sought by means of a postal survey of 100 Senior Registrars and recently-appointed Consultants in the specialty. Sixty-two replies were received. An overwhelming majority supported ACLS and ATLS certification, as well as formal training in Management/Clinical Budgeting skills, the use of Information Technology, dealing with medicolegal issues and Disaster Planning. Secondments to General Practice, Regional Poisons Centres and the Emergency Services were similarly recommended. A total of 71% (42 responders) approved of a minimum of 3 years experience in an A&E Department before appointment as a Senior Registrar in the specialty. The majority of responders disapproved of acquiring laboratory-based skills. The results of the survey are discussed and suggestions for the possible role of a logbook are made.

Certification↗
PubMed1990

General practice consultation patterns before and after intentional overdose: a matched control study.

This study investigated the general practice consultations of 46 patients during the year before and 13 weeks after hospital admission for deliberate self-poisoning. These were compared with data for controls matched for age, sex, family structure and area of residence. The frequency of consultations increased as parasuicide approached but this effect was due to large increases in a few patients. The greatest increase in the number of consultations and an increase in subjects consulting for physical problems occurred four to six months before the event. The seriousness of the attempt assessed by suicidal intent was unrelated to consulting pattern either before or after overdose. The rate of default from appointments was less than for controls, although this was not significantly different. Because of the problems in identifying when intentional self-harm will occur and the common presentation being psychosocial distress rather than mental illness, intervention to prevent parasuicide is likely to prove even more difficult than for suicide.

Adolescent↗
PubMed1989

Cantharis in the early treatment of minor burns.

The analgesic action of the homeopathic preparation Cantharis in the treatment of minor burns was assessed in a series of 34 patients. Under double blind conditions no statistically significant difference was found between Cantharis and a placebo.

Acetaminophen↗
PubMed1988

Early breast cancer: cosmetic and functional results after treatment by conservative techniques.

Between January 1980 and December 1985, 121 patients with early breast cancer were referred to the Department of Radiation Oncology at Westmead Hospital for radiation therapy following initial tumour excision. After a median follow-up of 26 months, five patients developed a loco-regional recurrence (4%) and nine developed metastatic disease but with local control. There were 105 eligible patients who were sent a letter/questionnaire which included: a request to attend a clinic, to allow an objective assessment of the cosmetic result of the treated breast by two clinicians, questions regarding breast function as it affected quality of life, and a request that they undertake a self-assessment of the treated breast from a cosmetic point of view. Seventy-six patients attended for assessment of the following factors: whether surgery was optimal as determined by predefined criteria, measurement of breast oedema, arm oedema, breast retraction and telangiectasia, and an overall cosmetic assessment performed independently by both a radiation oncologist and surgeon. A physician not involved in management undertook a cosmetic assessment using standard photographs. Approximately 20% of patients replied that their choice of clothing had been affected by treatment, 10% were embarrassed and 70% experienced some continuing tenderness or discomfort in their treated breast. The extent of surgery was judged to be suboptimal in 22% but that proportion increased to 34% of cases referred from external clinics. The overall incidence of moderate or severe breast oedema was 9%, breast retraction 50%, telangiectasia 16% and arm oedema 21%. Those patients with longer follow-up (i.e., greater than 36 months) had a higher incidence of breast retraction (67%), telangiectasia (30%) and arm oedema (33%) but less breast oedema (7%). As expected, the patients rated the appearance of their breast more favourably than did clinicians. Overall, the result was rated as good or excellent by 75% of patients compared with 55% when the assessment was made by a surgeon or radiation oncologist. The main factor identified as contributing to a poor cosmetic result was the area of the iridium implant. The area of implant was larger when suboptimal surgery had been carried out, the main component of which was excessive length of scar.

Breast↗