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Biomedical subjects

D Phillips

Publications and source records attributed to D Phillips.

At least 91 records · Page 5Linked to original sources
PubMed1996

Medical professional dominance and client dissatisfaction. A study of doctor-patient interaction and reported dissatisfaction with medical care among female patients at four hospitals in Trinidad and Tobago.

The aims of the study were to evaluate the presence of 'medical professional dominance' displayed by physicians, and to assess the levels of satisfaction with care received, as reported by a simple random sample of 320 patients on obstetric and gynaecology wards at four hospitals in Trinidad and Tobago. Professional Dominance was defined entirely in relation to quality of doctor-patient interaction, while patient satisfaction levels were reported measures. Two methods were used in the study: participant observation techniques were employed to obtain data on doctor-patient interaction, and the survey interview method was used for assessing levels of satisfaction of patients with care received. The results showed disturbingly high levels of both medical professional dominance and patient dissatisfaction. The results of similar studies carried out in the U.S.A. and Britain were used to draw a causative relationship between medical professional dominance and patient dissatisfaction.

Adolescent↗
PubMed1996

The Doppler kinetics of microbubble echo contrast.

The right and left heart kinetics of a saccharide-based microbubble echo contrast agent were measured in 11 anesthetized dogs using Doppler intensity as a measure of microbubble concentration while controlling for the dose administered, weight of the subject and cardiac output. A two-phase Doppler time-intensity curve was noted in all vascular regions. A brief first pass effect (phase 1) was found to depend on the contrast dose, cardiac output and subject size. This was followed by a much longer nearly steady-state elevation in the Doppler intensity compared with baseline (phase 2). The kinetics of phase 2 were found to be the same in all vascular distributions and independent of cardiac output. The phase 2 kinetics depend on the contrast dose, subject size and elimination characteristics of the contrast agent. The clinically important conclusions are: (1) the magnitude of Doppler enhancement and duration of the contrast effect can be predicted using the simple formulas presented; (2) the flow-dependent portion of the arterial contrast effect is effectively over only a few seconds after intravenous injection; and (3) the kinetics of phase 2 are the same throughout the body.

Animals↗
PubMed1996

The bone anchored hearing aid (BAHA) in chronic suppurative otitis media (CSOM).

Bone anchored hearing aids are gaining wide acceptability in the treatment of patients with congenital ear problems, chronic suppurative otitis media (CSOM) and in some cases otosclerosis. To date little information on the effect of the bone anchored hearing aid on the symptoms of chronic suppurative otitis is available. This retrospective study based on notes review and telephone interviews was to assess the outcome of bone anchored hearing aid surgery in patients with CSOM in terms of: ear discharge; surgical techniques and complications; the number of hours the aid is worn compared with the previous aid. One hundred and forty-two patients were fitted with bone anchored hearing aids without additional prostheses in Birmingham between 1989 and 1995. Sixty-nine (48.5 per cent) of these were for chronic suppurative otitis media, 45 of these were female and 24 were male with a mean age of 58 years. Most (85 per cent) had undergone previous ear surgery with 65 per cent having mastoid surgery. Ninety-eight per cent of this patient group had undergone single stage surgery and 65 per cent under local anaesthetic as a day case. A variety of techniques for soft tissue reduction were employed. The mean follow-up time for these patients was 24 months (range one month to seven years). No patients experienced worse discharge following their BAHA and 84 per cent had significantly reduced discharge, 16 per cent had no change. Complications included skin reactions, 15; failure to integrate, one; late loss of fixture, three. Seventy-three per cent wore their bone anchored hearing aid more than eight hours per day and 58 per cent were more satisfied with their bone anchored hearing aid than their previous aid.

Aged↗
PubMed1996

Conflict in close relationships: an attachment perspective.

This study investigated how perceptions of current dating partners and relationships change after people with different attachment orientations attempt to resolve a problem in their relationship. Dating couples were videotaped while they tried to resolve either a major or a minor problem. Confirming predictions from attachment theory, men and women who had a more ambivalent orientation perceived their partner and relationship in relatively less positive terms after discussing a major problem. Observer ratings revealed that more ambivalent women who tried to resolve a major problem displayed particularly strong stress and anxiety and engaged in more negative behaviors. Conversely, men with a more avoidant orientation were rated as less warm and supportive, especially if they discussed a major problem. These results are discussed in terms of how highly ambivalent and highly avoidant people differentially perceive and respond to distressing events.

Adolescent↗
PubMed1996

Do women want women health workers? Women's views of the primary health care service.

This paper sets out to explore key aspects of women's views of women GPs and practice nurses within primary health care settings. The extent to which women actively seek female health workers for the provision of their primary health care needs, including preventive health care, is examined. The findings presented in this paper are from a 3-year research project employing both quantitative and qualitative methods, which aimed to develop an understanding of the role women primary health care workers play in the construction and provision of primary health care services for women. The findings indicate that for specific 'women's health issues' the gender of the worker is clearly important for women. However, for other health needs factors such as the personal approach of the provider become paramount. Consideration of the role of the practice nurse suggests that there is considerable potential for practice nurses to further develop a specific role with women. Although lack of awareness among women of nursing skills and expertise raises issues for the presentation of the role of the practice nurse within the primary health care service. In conclusion the paper highlights that women's views should be understood in terms of a complex range of preferences and needs.

Adult↗
PubMed1996

Cocaine does not compromise cerebral or myocardial oxygen delivery in fetal sheep.

Eight time-dated pregnant ewes at 125 days' gestation (145 days = term) underwent surgery for placement of fetal vascular catheters, electrodes for recording fetal behavioural state, and maternal venous catheters. Three days later, fetal cerebral and myocardial blood flow were determined by the coloured microsphere technique under four conditions: (1) during rapid-eye movement (REM) sleep, before fetal cocaine infusion, (2) 30 min after initiation of a cocaine infusion to the fetus at 0.2 mg/kg per min, (3) during REM sleep, before maternal cocaine infusion, and (4) 30 min after initiation of a cocaine infusion to the ewe at 0.3 mg/kg per min. Cocaine infusion directly to the fetal lamb did not cause hypoxaemia or significantly change cerebral or myocardial blood flow or oxygen delivery. Cocaine administered to the ewe led to a drop in fetal oxygen tension from 3.0 +/- 0.5 to 2.5 +/- 0.3 kPa (P < 0.0001) and in fetal oxygen content from 3.8 +/- 0.7 to 2.8 +/- 0.4 mmol O2/L (P < 0.0001). Prior to maternal cocaine administration, fetal cerebral blood flow was 146 +/- 103 mL/100 g per min and during maternal cocaine infusion it went to 184 +/- 147 mL/100 g per min (P = NS) while myocardial blood flow increased from 156 +/- 92 to 333 +/- 178 mL/100 g per min (P < 0.002). This increase in blood flow negated the effects of hypoxaemia so that cerebral oxygen delivery was unaffected while myocardial oxygen delivery increased an average of 67%. It is concluded that cocaine administration to pregnant sheep does not impede fetal cerebral or myocardial oxygen delivery.

Analysis of Variance↗
PubMed1995

Fetal behavioral state patterns during and after prolonged exposure to cocaine in sheep.

OBJECTIVE: Studies on the effects of cocaine in fetal animals have been limited to acute exposures to the drug. We hypothesized that a prolonged infusion of cocaine to the fetal sheep would initially interrupt normal behavioral state cycling but the effects would be short lived as the fetus gained tolerance to the drug. STUDY DESIGN: The study was performed in a university laboratory on six time-dated pregnant ewes at 125 days' gestation. Fetal sheep, surgically instrumented 3 days before study, were given cocaine hydrochloride 0.6 mg/min for 6 hours. Fetal behavioral state before, during, and after the infusion was compared by repeated-measures analysis of variance. RESULTS: Infusion of cocaine caused a drop in the percentage time that the fetuses spent in both rapid-eye-movement (p < 0.03) and non-rapid-eye movement (p < 0.001) sleep, which was sustained throughout the 6-hour infusion. This was related to a decrease in the number of rapid-eye-movement and non-rapid-eye-movement episodes as opposed to a decrease in the lengths of these behavioral states. With cessation of cocaine infusion, the fetal sheep showed an increase in rapid-eye-movement sleep, with a higher percentage than during control periods (p < 0.02). CONCLUSIONS: Cocaine disrupts fetal rapid-eye-movement sleep without evidence for tolerance to the drug over a 6-hour period. "Catch-up" rapid-eye-movement sleep occurs with cessation of cocaine infusion. Neurobehavioral abnormalities associated with in utero cocaine exposure may be caused by chronic disruption of rapid-eye-movement sleep.

Analysis of Variance↗
PubMed1995

Modified transnasal endoscopic Lothrop procedure as an alternative to frontal sinus obliteration.

Persistent frontal sinusitis traditionally has been treated with external procedures such as osteoplastic frontal sinus obliteration or the Lynch procedure. Currently, functional endoscopic sinus surgery can be used in most cases to remove disease from the frontal recess, the most frequent site of frontal sinus obstruction, thereby relieving the sinusitis. In some cases, however, frontal recess exploration has failed to relieve the obstruction of the frontal sinus, necessitating an osteoplastic frontal sinus obliteration. We present our experience with a transnasal modification of the Lothrop procedure. The Lothrop procedure, first described in 1914, uses a combined external and transnasal approach to resect the median frontal sinus floor, superior nasal septum, and intersinus septum to drain the frontal sinus. This procedure was largely abandoned and forgotten by modern otolaryngologists. However, with the advent of the computed tomography scan and endoscopic techniques, we sought to reassess the basic tenant of the Lothrop procedure (i.e., wide median frontal sinus drainage). An anatomic study of cadaver heads was performed to quantify the surprisingly large potential opening and to better understand the pertinent anatomy. This procedure was performed on 10 patients, with no resulting complications and no failure to maintain patency of the frontal sinus drainage throughout the follow-up period (mean, 7 months). We are encouraged by our initial favorable results and intend to use the procedure in the future as needs arise.

Adult↗
PubMed1995

The socioeconomic geography of ethnic groups in two northern British cities.

"For the first time the 1991 British Census has not only provided data on ethnicity but has also cross-classified ethnic status by a variety of socioeconomic indicators. This paper is an exploration of the patterns revealed by these new data." The focus is on a comparative analysis of six ethnic groups living in the northern cities of Bradford and Leeds with regard to 30 demographic, household, employment, education, social class, and housing and consumption indicators. A picture of the relative situation of advantage and disadvantage among the ethnic groups considered is revealed.

Censuses↗
PubMed1995

Effect of nonviolent self-defense training on male psychiatric staff members' aggression and fear.

OBJECTIVE: Male staff members at two state psychiatric hospitals were trained in nonviolent self-defense skills for dealing with potentially assaultive patients to determine whether such training could reduce the number of assaults and episodes of patient restraint. METHODS: Three groups of male staff received didactic training, didactic and physical skills training, or no training in the nonviolent self-defense skills of protective profile, repel, and push-off, as well as in evasive movement. Effects of the training were evaluated using the Buss-Durkee Hostility-Guilt Inventory; a questionnaire about clinical experience and sports training; judges' evaluations of physical skill, aggression, and fear; a self-report questionnaire about the value of nonaggressive responses and felt fear and aggression; and a follow-up questionnaire about posttraining assaults. RESULTS AND CONCLUSIONS: Behaviorally expressed fear and aggression were significantly reduced among staff who received both didactic and physical skills training. The other two groups showed no significant changes in this area. During the two weeks after training, subjects trained in physical and didactic skills were involved in 23 percent fewer assaults than those who received only didactic training and 20 percent fewer assaults than those who received no training. The development of increased skill in nonviolent physical techniques of self-defense was strongly correlated with an increase in the value placed on the use of the skills and on nonviolent outcomes.

Aggression↗
PubMed1995

Comparison of DNA measurement performed by flow and image cytometry of embedded breast tissue sections.

Tissue sections are important for morphometric studies, such as the analysis of architectural pattern of tissues as well as nuclear morphology and chromatin texture describing DNA distribution in nuclei. Tissue sections are generally not recommended for use in DNA ploidy measurements due to possible errors based on sectioned and overlapped nuclei. However, image cytometry (IC) on tissue sections has the advantage of preserved architecture and selective sampling of nuclei. This is particularly important for the analysis of specimens with small areas of diseases tissue or with a variety of histologic patterns in the same region, such as premalignant changes or in situ tumors. To evaluate the potential of measurements on breast tissue sections in the estimation of DNA ploidy status, we compared IC and flow cytometry (FC) measurements on formalin-fixed breast cancer tissue from 51 paraffin-embedded blocks. For each specimen the DNA index and ploidy were determined by both methods. DNA indices of IC and FC corresponded roughly in 66% of cases. Agreement in ploidy was achieved in about 80% (40/51) of cases, where some of the discrepancies could be explained by the differences between invasive cancer and ductal carcinoma in situ (DCIS) illustrated by IC. Both methods agreed highly in aneuploid cases. However, about 50% of FC diploid cases were aneuploid by IC. Despite significant shortcomings of measurements obtained on archival tissues, meaningful data can be obtained not only by FC but also by IC performed on tissue sections.(ABSTRACT TRUNCATED AT 250 WORDS)

Aneuploidy↗
PubMed1995

Functional maturation of neuroendocrine gonadal axis is altered by specific phase relations of circadian neurotransmitter activity in Japanese quail.

The present study was designed to ascertain the effects of temporal relationship of circadian neural oscillations on puberty attainment and reproductive growth of Japanese Quail, Coturnix coturnix japonica. Serotonin and dopamine precursors (5-hydroxytryptophan, 5-HTP and L-dihydroxyphenylalanine, L-DOPA; 5 mg/100 g body weight) were injected daily, 8 and 12 h apart in two groups of one-day old chicks, while controls received two daily injections of normal saline. Weekly/biweekly observations (body weight, cloacal gland size, testicular volume and activity, ovarian follicular diameter and rate of egg production) were made until 9 weeks of age, when the experiment was terminated. Results indicate that 8 h relationship completely suppressed gonadal growth even under long photoperiod (LD 16:8), while a 12 h relationship induced precocious sexual maturity and increased the rate of reproduction (spermatogenesis and egg production). It is concluded that circadian phase relationship of serotonergic and dopaminergic activity may not only determine the onset of reproduction in this poultry species, but may also alter the rate of reproduction possibly by affecting photoperiodic mechanism of reproductive regulation.

Animals↗