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Biomedical subjects

D Jewell

Publications and source records attributed to D Jewell.

18 recordsLinked to original sources
PubMed1991

Contribution of general practitioners to hospital intrapartum care in maternity units in England and Wales in 1988.

OBJECTIVE: To ascertain the contribution of general practitioners to hospital intrapartum care in 1988. DESIGN: Confidential postal questionnaire. SETTING: All maternity units in England and Wales. MAIN OUTCOME MEASURES: Type of general practitioner unit (if any); number of bookings, transfers, and deliveries by general practitioners; participation of general practitioners in the policy and audit of the unit. RESULTS: 277 (93%) of 297 units replied. Of 611,644 deliveries, 36,043 (5.9%) were under general practitioner care. In all, 228 units permitted general practitioners to book women under their sole care: 65 were isolated, 29 alongside, and 134 integrated general practitioner units. Alongside units had significantly more bookings (568), antenatal transfers (69), intrapartum transfers (86), and deliveries (387) compared with isolated units (185, 18, 16, and 125, respectively) and integrated units (106, 18, 18, and 52) (p less than 0.001 for all differences). The percentage of women booked by general practitioners transferred either before or during labour was independent of both the type of unit and the number of general practitioner bookings. General practitioners in consultant units were significantly less likely to attend meetings reviewing perinatal mortality (p less than 0.01), and these units were less likely to have any form of general practitioner-consultant liaison committee (p less than 0.001) compared with general practitioner units as a whole. Compared with those in isolated and alongside units, general practitioners in integrated units were less likely to have taken part in deciding the unit's booking policy (p less than 0.01) and consultants more likely to be the final determinant of whether a general practitioner should be permitted to practice within the unit (p less than 0.001). CONCLUSIONS: Both the number of deliveries booked by general practitioners and the number of isolated general practitioner units have fallen. Transfer from general practitioner to consultant care was independent of the general practitioner unit's caseload or the type of unit. General practitioner units differ from consultant units in important ways and differ among themselves as well. Except in remote areas, alongside units may be the ideal type of unit to encourage general practitioners to continue to provide intrapartum care.

Delivery Rooms↗
PubMed1991

Lymphocyte subset reference ranges in adult Caucasians.

We report here the distributions of lymphocyte populations bearing the following antigens: CD3 (T cells), CD19 (B cells), CD4 (T helper/inducer cells), CD8 (T suppressor/cytotoxic and some NK cells), and CD3-, CD16+, and/or CD56+ (NK cells). At four sites, analyses were performed on healthy, normal subjects between the ages of 18 and 70, using identical flow cytometry systems and techniques. Reference ranges (unadjusted for sex differences and age variation) are CD3 (61 to 85%), CD19 (7 to 23%), NK (6 to 29%), CD4 (28 to 58%), and CD8 (19 to 48%). The lymphocyte subpopulation distributions for all antigens were found to be similar at all sites. By combining data from all sites, it has been possible to estimate age variation and sex differences for each of these subpopulations. Age and sex associated differences are substantial for some lymphocyte subsets (CD3, CD4, NK cells), and proper accounting of these effects is essential in evaluating the individual patient, if further disease-related variation is to be accurately and consistently assessed. It appears possible to recommend reference ranges for lymphocyte population parameters applicable across national and laboratory boundaries. These ranges provide a basis for comparing results from different institutions and for combining such results on subjects and patients from several institutions, provided the methodology and equipment are identical at all sites.

Adolescent↗
PubMed1991

Medical hazards of a four-km fun run.

An observational study was conducted of participants in a 4-km race with the object of identifying risk factors for a poor outcome. Sixteen individuals were identified who required medical assistance at the end of the race. Pulse and lying and standing blood pressure were measured and a brief history was taken. Compared with 92 controls, the subjects showed a greater orthostatic drop in systolic blood pressure and were more likely to have consumed alcohol in the preceding 24 h.

Adult↗
PubMed1990

Prepregnancy and early pregnancy care.

There is ample evidence to support the familiar message offered to women early in pregnancy that they should stop smoking, limit their alcohol intake to less than two units daily, avoid all unnecessary drugs and eat a normal well-balanced diet. They may continue to take exercise and work (in almost all occupations) without any risk to the fetus. For doctors the challenge is to balance their wish to pass on the scientific evidence with the obligation to address the concerns and needs of their individual patients. Routine screening in early pregnancy should be continued for syphilis and rubella, but the benefits do not justify it for other infectious illness, including urinary tract infection. The arguments for screening for toxoplasmosis in pregnancy are finely balanced; if more effective treatment were available then screening might become worthwhile. Provided a full screening programme for cervical cancer is achieving reasonable coverage for the adult female population, there is no need for additional screening in pregnancy. Unplanned and unwanted pregnancy is a substantial problem in the United Kingdom and will continue to be so. For those that request it, termination is a safe procedure with low morbidity, especially when carried out early on. Women with unplanned pregnancies are entitled to advice from their doctors in order to help them decide whether they want a termination or not.

Abortion, Legal↗
PubMed1989

Bleeding in early pregnancy.

Bleeding in pregnancy is a distressing experience for any woman, particularly if she has had a previous miscarriage. Though often offered, hospital admission is thought to have no prognostic advantage over home management. A factor not always considered is the need for administration of anti-D immunoglobulin to rhesus-negative women.

Abortion, Threatened↗
PubMed1989

Growth hormone treatment reduces total body fat accumulation in Zucker obese rats.

Lean and obese Zucker rats were injected daily intraperitoneally with high doses (5-10 mg/kg) of human growth hormone (GH) for 3 weeks. In the obese rats after GH treatment, carcass lipid was decreased by 50 percent, and bone weight increased to levels of lean controls. During the last two weeks of GH treatment, food intake was increased in lean rats and not significantly affected in obese rats. Loss of body weight in obese animals was masked by water retention. Serum insulin concentrations were doubled in obese animals but unchanged in lean phenotypes after GH treatment. Hepatic fatty acid oxidation in obese animals was stimulated 5-fold by treatment, while hepatic lipid synthesis was stimulated 2-fold and adipose lipid synthesis was reduced 3-fold. These results suggest that growth hormone induces a partitioning of nutrients in obese rats which results in less lipid accumulation.

Adipose Tissue↗
PubMed1988

Learning through examinations: use of an objective structured clinical examination as a teaching method in general practice.

An objective structured clinical examination was written to evaluate the primary care teaching in Southampton medical school's third year curriculum. Its transition from a summative to a formative evaluation is described. During the academic year 1985-86 the examination was completed by 115 students in 12 groups, and the results give some support to its validity. Students reported that they had learnt from the exercise and the reasons for this are discussed.

Achievement↗
PubMed1986

Chronic inflammatory bowel disease, cigarette smoking, and use of oral contraceptives: findings in a large cohort study of women of childbearing age.

Since the start in 1968 of the Oxford Family Planning Association contraceptive study 31 women have developed ulcerative colitis and 18 have developed Crohn's disease, giving incidences of 0.15 and 0.09/1000 woman years respectively. The incidence of ulcerative colitis in women who were non-smokers on entry to the study was 0.17/1000 woman years and the incidence in smokers was 0.11/1000 woman years. The findings for Crohn's disease were entirely different, the corresponding incidences being 0.05 and 0.17/1000 woman years respectively. Both ulcerative colitis and Crohn's disease were more common among women currently using oral contraceptives than among those not doing so. Incidences per 1000 woman years for ulcerative colitis were 0.26 in users and 0.11 in non-users; for Crohn's disease the incidences were 0.13 and 0.07 respectively. Though the association between the use of oral contraceptives and chronic inflammatory bowel disease cannot be regarded as established, the effects of smoking have been shown consistently in many studies. This observation provides an important clue to the aetiology of chronic inflammatory bowel disease.

Adult↗
PubMed1985

Common childhood problems: variation in management.

A patient management questionnaire was written to assess the range of advice being offered to parents on common paediatric problems. It was sent to hospital doctors, clinical medical officers, health visitors, and general practitioner trainers and trainees. In the 95 completed questionnaires just over half the items elicited conflicting advice, and some differences between different professional groups could be identified. It is suggested that such conflicts are potentially damaging to relationships between patients and health care professionals and that there are ways to avoid conflict.

Child↗